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AN  ESSAY 


ON  THE 

NATURE  OF  THE  EPIDEMIC 

USUALLY  CALLED 

ASIATIC  CHOLERA,  &c. 

WITH  THE 

REASONS  WHY  IT  SHOULD  BE  REGARDED  AS  AN 

EPIDEMIC  DIARRHCEA  SEROSA 

INSTEAD  OF 

COMMON  CHOLERA  MORBUS; 

AND  AN  ATTEMPT 

TO  FOUND  THE  TREATMENT 

UPON  THE 

PATHOLOGY  OF  THE  DISEASE: 

BEING  THE  ANNUAL  COMMUNICATION  TO  THE  MEDICAL 
SOCIETY  OF  THE  STATE  OF  NEW-YORK. 

February  5,  1833, 

BIT  THOMAS  SPENCER,  M.  D.  President. 

HONORARY  MEMBER  OF  THE  KENTUCKY  AND  PHILADELPHIA  MEDICAL  SOCIETIE 
CORRESPONDING  MEMBER  OF  THE  ALBANY  LYCEUM  OF  NATURAL  HISTORY,  &C. 


ALBANY: 

PRINTED  BY  WEBSTER  AND  SKINNERS. 


1833. 


I 


CONTENTS. 

Page. 

Preliminary  Discourse,  - --  --  --  --  - 7 

Chapter  x.  Of  the  causes,  symptoms,  appearances  on 

dissection,  and  analysis  of  the  blood,  -----  10 

1.  Causes,  - --  --  --  - ib. 

2.  Symptoms  of  the  first  stage,  - --  --  --  -11 

3.  “ “ second,  - -12 

4.  “ “ third,  13 

“ “ “ (a)  Collapse,  (b)  Reaction,  14 

5.  “ “ fourth  stage,  - --  --  --15 

6.  Prognosis,  - --  --  --  - 16 

7.  Appearances  on  dissection,  - --  --  --  -17 

8.  Changes  of  the  blood,  - --  --  --  --20 

Chapter  it.  Division  of  symptoms  into  constant  and 

occasional,  - --  --  --  --  --  --21 

1.  Of  the  constant  symptoms, --ib. 

2.  “ occasional  symptoms,  - --  --  --25 

Chapter  hi.  Of  the  pathology  of  the  first  stage,  - - - 27 

1.  Remarks  on  epidemics  and  their  laws,  -----  ib. 

2.  Modus  operandi  of  the  epidemic  influence,  - - - 31 

3.  Of  intemperance  and  filth  as  predisposing  causes,  - 36 

4.  Recapitulation,  - --  --  --  --  --  -37 

Chapter  iv.  Of  the  pathology  of  the  second  stage,  - - ib. 

1.  Of  the  origin  of  the  intestinal  discharges,  - - - ib. 

2.  Of  the  immediate  cause  of  the  discharges,  - - - 42 

3.  Of  their  effects  upon  the  circulating  fluids,  - - - 43 

4.  “ circulation,  ------  45 

5.  “ respiratory  & capillary  functions,  48 

6.  “ secretions  and  excretions,  - - 49 

7.  “ absorbent  system,  - - - - 52 

S.  “ functions  of  animal  life,  - - 53 

9.  Recapitulation,  - --  --  --  --  --  -60 

Chapter  v.  Of  the  pathology  of  the  third  and  fourth 

stages,  (a)  collapse,  (b)  reaction,  (c)  consecutive  fever,  60 
Chapter  vi.  Of  the  pathological  relations  and  complica- 
tions of  diarrhoea  serosa  with  other  diseases,  - - 65 

1.  Of  its  relations  to  other  forms  of  diarrhoea,  - ib. 

2.  “ complications  with  other  diseases,  - - 6S 


iV  CONTENTS. 

Chapter  vii.  Of  the  name  and  diagnosis  of  the  epidemic,  72 
Chapter  viii.  Of  the  non-contagious  character  of  the  disease,  76 
Chapter  ix.  Of  the  treatment  of  the  first  stage,  - - - SI 

1.  Of  the  individual  means  of  avoiding  the  disease,  ib. 

2. t  “ public  means  of  preventing  the  epidemic,  84 

3.  “ remedies  for  the  first  stage,  - - - - 90 

Chapter  x.  Of  the  treatment  of  the  second  stage,  - - 93 
Chapter  xi.  Of  the  treatment  of  the  collapse,  - - - - 102 
Chapter  xii.  Of  the  treatment  of  the  consecutive  fever,  - 113 
Appendix — Cases,  - - - - 119 


TO  THE  REABmi. 


In  the  following  Essay,  I have  principally  written  the  re- 
sults of  my  own  observation.  To  the  labors  of  others  I have 
however  been  much  indebted.  Nearly  three  weeks  had  been 
spent  amidst  the  epidemic,  before  arriving  at  the  views  here 
presented  of  the  nature  of  the  disease.  A treatment  against 
which  strong  prejudices  had  been  previously  entertained, 
but  founded  upon  this  pathology,  had  been  subjected  to  the 
test  of  successful  experiment  equal  to  the  most  sanguine  ex- 
pectations ; and  the  belief  was  fully  entertained  that  all  the 
phenomena  of  the  disease  could  be  satisfactorily  accounted 
for,  and  that  the  remediate  means  could  be  conducted  upon 
those  rational  principles  which  govern  the  treatment  of  other 
diseases,  whose  nature  is  understood,  before  the  idea  occur- 
red that  it  was  the  Diarrhoea  Serosa  of  medical  writers?  It 
will  hence  appear,  that  this  name  has  not  been  adopted  for 
the  purpose  of  coming  in  collision  with  my  medical  breth- 
ren, but  as  a deduction  from  pathological  views  previous- 
ly entertained.  No  farther  consideration  is  asked  for  these 
views,  than  their  candid  subjection  to  those  tests  which  are 
an  unerring  guide  to  truth — a divinity  to  which  every  med- 
ical practitioner  should  pay  unceasing  homage.  If  they  will 
not  bear  this  test,  let  them  be  rejected.  The  pathology  was 
deduced  from  a separate  analytical  examination  of  each  phe- 
nomenon of  the  disease,  not  in  the  order  here  presented,  for 


VI. 


TO  THE  READER. 


in  conducting  these  researches,  I often  found  myself  like  the 
traveller  without  a guide,  in  a land  unknown,  -wandering  in 
the  labyrinth  of  uncertainty,  and  occasionally  finding  truth  as 
a resting  place.  Although  satisfied  of  the  general  correct- 
ness of  these  views,  yet  exemption  from  error  is  not  claim- 
ed. It  is  notwithstanding,  a task  of  exceeding  difficulty  to 
conduct  others  by  the  same  route  by  which  we  ourselves  ar- 
rive at  results,  or  to  satisfy  them  that  they  are  true.  The 
symptoms  of  the  latter  stages  were  first  subjected  to  examin- 
ation, but  it  was  soon  found  that  the  first  dawnings  of  the 
disease  must  be  fully  traced,  and  their  relations  as  effects 
must  be  connected  with  the  original  causes,  in  order  satisfac- 
torily to  account  for  the  concatenation  of  phenomena  which 
constitute  the  entire  disease.  In  the  hope  of  contributing 
my  mite  towards  improving  the  knowledge  of  its  nature  and 
treatment,  and  of  aiding  the  investigations  of  those  who 
have  not  witnessed  this  terrific  epidemic,  the  following  es- 
say is  submitted  to  a candid  public. 


Spencer  on  Asiatic  Cholera. 


7 


Art.  VI.  Annual  Address , on  the  Nature  of  the  Epidemic , 
usually  called  Asiatic  Cholera,  fyc.  Delivered  be- 
fore the  Society,  Feb.  5,  1833.  By  Thomas  Spencer, 
M.  D.  President,  Honorary  Member  of  the  Kentucky  and 
Philadelphia  Medical  Societies,  Corresponding  Member 
of  the  Albany  Lyceum  of  Natural  History,  fyc. 

Epidemics  have  in  every  age  excited  the  dismay  of 
mankind,  and  swept  from  the  stage  of  human  action  a vast 
proportion  of  the  inhabitants  of  the  globe.  The  apprehension 
they  produce  is  greatly  enhanced  by  the  rapidity  of  their 
movements,  and  the  mysterious  character  in  which  these  in- 
sidious enemies  are  enshrouded.  It  therefore  becomes  pe- 
culiarly important  that  the  nature  of  every  disease  prevailing 
under  this  form,  should  be  carefully  investigated,  and  that 
the  symptoms  and  mode  of  treatment  found  most  successful, 
should  be  faithfully  recorded.  This  may  serve  as  a beacon  in 
after  time,  to  guide  the  enlightened  physician  in  his  prescrip- 
tions, whenever  such  disease  recurs,  and  tend  greatly  to  miti- 
gate the  terror  which  severe  epidemics  universally  bring  in 
their  train.  In  performing  the  duty  imposed  by  the  ordinances 
of  this  society,  I cannot  perhaps  offer  any  thing  more  accepta- 
ble than  the  result  of  my  observations  and  reflections  upon 
the  disease  which  has  recently  produced  such  general  devas- 
tation throughout  the  habitable  globe. 

This  epidemic  commenced  at  Jessore,  a city  nearly  one 
hundred  miles  northeast  of  Calcutta,  in  August,  1817.*  It 
was  at  first  regarded  as  a new  disease ; and  it  is  still  consid- 
ered by  many  as  such,  but  it  is  believed  that  a similar  one 
has  been  described  by  Hippocrates,  Sydenham,  Morgagni, 
and  a host  of  other  distinguished  teachers,  and  practitioners  of 
the  healing  art.  If  the  present  epidemic  has  spread  more 
universally  than  most  others  of  the  same  character,  which 
have  preceded  it,  yet  we  cannot  but  be  forcibly  struck  with 
the  marked  similarity  in  the  description  of  symptoms  which 
obtains  in  almost  all  the  writers  from  the  earliest  records  of 


* Brigham. 


8 


Spencer  on  Asiatic  Cholera. 


medicine.  A few  discrepancies  could  indeed  be  pointed  out, 
but  they  are  sufficiently  explainable  from  the  known  diversi- 
ties in  the  character  of  every  epidemic  disease,  as  it  returns 
at  different  periods.  In  the  brief  limits  which  custom  has 
assigned  to  an  annual  communication  to  this  society,  it  can- 
not be  expected  that  I should  go  fully  into  the  history  of  the 
disease  under  consideration  ; and  indeed,  if  time  would  per- 
mit, it  might  be  regarded  as  a labor  of  supererogation,  so  fully 
and  ably  has  this  been  done  by  others.  I shall,  therefore, 
principally  confine  myself  to  a detail  of  the  symptoms  and  the 
practical  results  to  which  my  observation  and  investigations 
have  conducted  me. 

The  recent  epidemic  has  a received  a diversity  of  ap- 
pellations at  the  different  periods,  and  in  the  various  pla- 
ces in  which  it  has  occurred.  In  the  East  Indies,  where 
it  frequently  appeared  previous  to  1817,  it  received  the 
name  of  “ mort-du-chien ,”  and  is  probably  the  same  dis- 
ease which  at  an  earlier  period  was  designated  as  the  cold 
plague.  Since  1817  it  has  by  some  been  considered  a ma- 
lignant fever , has  been  denominated  phlegmorrhagia , but 
has  more  commonly  received  the  name  of  cholera , either 
singly,  or  coupled  with  some  qualifying  word,  as  epidemic, 
Indian , malignant,  contagious,  asphyxia,  typhoides,  spas- 
modic, or  Asiatic  cholera.  Names  are  of  little  consequence, 
unless  they  lead  to  erroneous  views  in  relation  to  the  na- 
ture and  treatment  of  disease ; but  whenever  this  occurs, 
a corrective  becomes  important.  It  is  conceived  that  this  has 
happened  in  relation  to  the  present  disease;  and  I have 
in  a hasty  and  brief  essay  heretofore  announced  to  the  public, 
the  opinion  that  it  is  a disease  long  known  by  the  name  of 
diarrhaza  serosa,  appearing  under  an  aggravated  and  ma- 
lignant form,  as  an  epidemic.  Since  the  epidemic  com- 
menced in  India,  every  writer  has  seemed  to  consider  him- 
self at  liberty  to  give  it  such  a name  as  his  views  of  its  nature 
or  the  presence  of  some  accidental  symptom  dictated.  This 
circumstance  has  contributed  to  involve  our  ideas  of  this  dis- 
ease in  very  great  confusion  ; and  I freely  confess,  that  my 


Spencer  on  Asiatic  Cholera.  9 

anxious  examination  of  the  various  publications  upon  its  na- 
ture and  treatment,  previous  and  preparatory  to  witnessing  its 
phenomena,  only  tended  to  render  “ confusion  worse  con- 
founded.’5 Names  of  diseases,  as  well  as  every  thing  else,  are 
conventional,  and  every  author  has  of  course  the  right  to  use 
them  in  such  sense  as  he  pleases,  provided  he  seasonably  ap- 
prises us  of  his  meaning.  In  the  medical  profession,  a frequent 
ehange  of  the  names  of  diseases  is  often  productive  of  mis- 
ehief;  and  it  is  believed  that  an  error  of  name  and  diagnosis 
has  greatly  added  to  the  fatality  of  the  present  epidemic.  This 
error  has  led  physicians  to  overlook  the  first  stage  of  the  dis- 
ease, in  consequence  of  a change  of  name  when  it  advances, 
and  the  severe  symptoms  appear ; and  also  to  confound 
two  diseases  essentially  different  in  their  nature  in  their  first 
stages,  which  as  they  advance  to  a dangerous  or  fatal  period, 
present  a similar  train  of  symptoms.  It  is  intended  in  the 
sequel  to  use  the  terms  Cholera  and  Diarrhoea  Serosa,  in  the 
sense  which  was  generally  attached  to  them  by  the  profession 
previous  to  1817.  By  cholera , is  meant  “ vomiting  and  fre- 
quent purging  of  a bilious  humour , anxiety,  gripes,  spasms 
of  the  legs.”*  By  diarrhoea  serosa,  is  meant,  u watery  loose- 
ness. The  dejections  almost  entirely  liquid,  frequently  me- 
tastastic,  and  still  oftener  produced  by  elaterium , or  other 
drastic  purgatives.  Sometimes  urinous,  occasionally  tinged 
with  blood.” f This  definition  of  Dr.  Good  describes  the  phe- 
nomena of  the  disease  much  better  than  his  description  of  the 
“ cholera  spasmodica,”  a complaint  which  he  had  not  wit- 
nessed, when  he  wrote  his  nosology;  and  this  sufficiently 
explains  the  circumstance  of  his  having  given  two  names  to 
the  same  disease  in  his  arrangement,  especially  as  this,  like 
all  other  maladies,  assumes  an  aggravated  and  altered  cha- 
racter on  becoming  epidemic.  Sauvages  and  Young  describe 
it  under  the  same  term.  It  is  called  by  Hoffman,  Parr,  and 
others,  diarrhoea  aquosa ; and  it  has  been  known  among 
writers  by  this  term,  or  one  expressing  the  same  meaning, 


* Cullen’s  Nosology. 


f Good’s  Nosology. 


10 


Spencer  on  Asiatic  Cholera. 


from  Hippocrates  to  the  present  day.  The  term  cholera , has 
been  much  more  vaguely  used  than  diarrhoea  serosa,  and  it 
is  believed  that  the  former  being  applied  to  the  present  epi- 
demic, has  been  a principal  cause  of  its  pathology  remaining 
so  long  unknown.  The  term  cholera  has  become  so  much 
associated  with  our  ideas  of  vomiting  in  intestinal  diseases, 
that  it  is  too  often  applied  to  complaints  where  vomiting 
should  be  regarded  as  an  accidental  symptom.  The  proba- 
bility that  this  epidemic  will  frequently  recur,  renders  it  a 
subject  of  deep  and  abiding  interest.  It  is  proposed,  by  di- 
vesting it  of  mysticism  ; and  by  establishing  the  identity  of 
the  seat  and  nature  of  disease  in  diarrhcea  serosa , and  the 
epidemic ; by  accommodating  the  remedies  to  the  varying 
conditions  of  the  system,  in  the  different  stages  ; to  rescue  the 
treatment  from  empiricism,  and  establish  it  upon  a rational 
and  an  enduring  basis.  This  is  a desideratum  of  such  im- 
measurable importance  to  the  profession,  and  to  the  para- 
mount interests  of  humanity,  that  however  diffidently  I may 
commence,  or  imperfectly  perform  the  effort,  may  I not  be 
cheered  by  the  consolatory  reflection,  that  even  an  attempt 
of  this  kind  will  be  duly  appreciated  by  an  anxious  and  in- 
dulgent public. 

CHAPTER  I. 

OF  THE  CAUSES,  SYMPTOMS,  APPEARANCES  ON  DISSECTION, 
AND  ANALYSIS  OF  THE  BLOOD. 

1.  Causes. — The  first  and  moving  cause  of  this,  and  all  wide 
spread  epidemics,  is  known  alone  to  Him,  who  has  established 
those  general  laws  by  which  universal  nature  is  governed.  From 
the  history  of  the  disease,  which  has  now  extended  its  rava- 
ges throughout  the  habitable  globe,  it  is  evident,  that  although 
some  all  of  ranks,  ages  and  conditions  have  been  its  victims, 
yet  its  principal  fury  has  been  spent  upon  the  intemperate, 
the  filthy  and  the  profligate.  We  may  therefore  safely  rank 
among  the  predisposing  and  exciting  causes,  intemperance, 


Spencer  on  Asiatic  Cholera. 


11 


uncleanliness  and  profligacy.  To  these  may  be  added,  fa- 
tigue, mental  and  corporeal,  grief,  despondency,  cathartic 
drugs,  indigestible  meals,  fear,  exposure  to  cold,  debilitating 
diseases,  and  whatever  enfeebles  the  constitutional  powers. 

2.  Symptoms  of  the  first  stage. — The  disease  has  generally 
been  divided  into  four  stages,  and  although  nature  has  not  as 
in  many  other  complaints  drawn  a certain  line  of  demarcation 
between  them,  yet  it  is  deemed  expedient  to  conform  to  this 
division.  The  first  has  been  denominated  the  “ premonito- 
ry stage  f but,  for  reasons  to  be  fully  detailed  as  we  advance, 
the  diarrhoea  has  the  highest  claim  to  be  considered  as  the 
first  stage  of  an  uninterrupted  chain  of  phenomena,  which, 
with  the  exception  of  consecutive  fever,  constitute  the  entire 
disease.  The  earliest  symptom  that  has  been  observed,  is  a 
furred,  white,  slimy  tongue ; generally  accompanied  by  dis- 
tress and  faintness  at  the  pit  of  the  stomach.  Diarrhoea,  gen- 
erally of  a milky  or  watery  character  supervenes,  which  is  of 
uncertain  duration,  sometimes  making  its  onset  suddenly  and 
severely,  soon  running  into  the  second  stage,  at  others  con- 
tinuing several  days  alternately  checked  or  aggravated.  In- 
voluntary discharges  from  the  bowels  have  often  taken  place 
while  the  person  is  standing  in  company;  scarcely  a pain  an- 
nouncing the  existence  of  the  enemy  within,  and  which  is 
insidiously  undermining  the  constitution.  The  features  be- 
come sharpened  from  emaciation,  the  patient  complains  of 
languor  and  debility,  and  evinces  an  indisposition  to  corporeal 
and  mental  exertion.  The  food  remains  many  hours  unchang- 
ed upon  the  stomach  ; and  even  wine  has  been  vomited  al- 
most unaltered,  some  twelve  or  fourteen  hours  after  it  was 
swallowed.  Slight  nausea,  cold  clammy  feet,  and  a sensa- 
tion as  if  the  whole  bowels  were  to  be  expelled,  when  little 
passes  them,  are  frequent  symptoms.  The  pulse  is  not  great- 
ly changed  from  the  standard  of  health,  being  at  times  increased 
in  frequency,  and  exhibiting  evidence  of  slight  febrile  action. 
There  is  a dryness  of  the  surface,  also  scantiness  of  urine, 
which  is  at  times  voided  with  difficulty.  Although  there  may 
occasionally  be  an  admixture  of  biliary  matter,  giving  the 


12 


Spencer  on  Asiatic  Cholera. 


evacuations  a yellow  or  dark  colour,  vet  the  intestinal  evacua- 
tions generally  evince  an  entire  suspension  of  the  hepatic 
secretion. 

3.  Symptoms  of  the  second  stage. — Almost  all  the  organs 
on  which  life  depends  becoming  primarily  or  secondarily 
drawn  into  deranged  action,  this  may  properly  be  denomina- 
ted the  stage  of  commotion . Dizziness,  deafness,  difficulty 
of  making  water,  and  a violent  agitation  and  rumbling  in 
the  bowels,  generally  with  little  pain,  but  occasionally  at- 
tended with  gripings,  usher  in  this  stage.  Vomiting  and 
purging  of  a watery  fluid,  unmixed  with  bile,  now  come  on. 
Discharges  sometimes  rice-coloured,  at  others  the  colour 
of  dirty  water,  again  assuming  a reddish  hue,  resembling  the 
washings  of  beef,  but  frequently  so  clear  and  transparent  that 
you  can  see  to  the  bottom  of  the  vessel,  are  evacuated  in  im- 
mense quantities.  They  are  of  a saline  taste,  and  have  occa- 
sionally a urinous  smell.  Small  flocculse  are  generally  seen 
floating  upon  the  surface  of  these  discharges.  Spasms  frequent- 
ly supervene  as  the  disease  advances,  and  rouse  the  patient 
from  an  apparent  condition  of  ease  and  quiescence,  and  he  often 
calls  anxiously  upon  the  bye-standers  to  make  use  of  fric- 
tions to  the  extremities.  The  muscles  rise  into  hard  balls, 
remaining  contracted  for  some  time.  In  general  these  spasms 
affect  the  muscles  of  one  limb,  or  part  of  the  body  at  a time, 
although  cases  occasionally  occur,  in  which  a large  propor- 
tion of  the  muscles  seem  to  he  simultaneously  affected  with 
tonic  spasms.  In  a few  instances  convulsions  suddenly  su- 
pervene, upon  the  patient  assuming  an  erect  posture,  but  they 
soon  subside.  At  other  times  a tremulous  motion  of  the 
muscles  is  observable.  Vomiting  and  spasms  are  by  no  means 
uniform  symptoms.  Intense  thirst  attends  this  stage,  but  in 
the  advanced  part  the  patient  seems  to  evince  little  anxietv 
for  any  thing  else  but  drinks.  The  breathing  is  in  general 
slowly  performed,  and  in  the  intervals  of  spasms  and  vomit- 
ing, the  patient  is  in  a half  dosing  posture,  seeming  scarcely  to 
exert  his  intellectual  faculties.  Great  dullness  of  mind  ex- 
ists, and  patients  who  had  previous  to  the  attack,  indulged 


Spencer  on  Asiatic  Cholera. 


13 


the  most  fearful  apprehensions,  appear  regardless  of  the  result; 
yet  on  being  roused,  not  the  slightest  aberration  of  intellect  is 
observable.  Exceptions  maybe  occasionally  found  in  which 
the  functions  of  the  brain  seem  to  participate  in  the  over- 
whelming impression  of  the  disease  upon  all  the  organs,  evinc- 
ed by  suspension  of  the  mental  operations.  In  the  early 
part  of  this  stage,  the  pulse  is  somewhat  contracted  and  ac- 
celerated ; as  the  stage  advances,  it  becomes  more  and  more 
feeble,  not  generally,  though  at  times  rapid,  varying  in  fre- 
quency, according  to  the  position  of  the  patient  and  the  treat- 
ment which  has  been  pursued.  Coldness  of  the  surface  con- 
stantly increases  as  this  stage  advances  ; profuse  sweating  and 
corrugated  hands  supervene,  and  the  skin  progressively  as- 
sumes a purple  or  dusky  brown  hue.  The  muscular  power 
frequently  remains  in  a remarkable  degree,  enabling  the  pa- 
tient to  turn  himself  in  bed,  and  even  get  upon  his  feet.  In 
the  erect  posture  he  is  liable  to  swooning.  When  the  dis- 
charges are  of  the  colour  of  dirty  water,  the  smell  is  some- 
what feculent,  while  those  that  are  rice  coloured  or  clear,  are 
inodorous,  or  of  a urinous  smell. 

4.  Symptoms  of  the  third  stage.- — This  is  usually  denom- 
inated the  stage  of  collapse,  but  it  is  deemed  expedient  to  in- 
clude the  reaction  in  it,  which  is  unattended  with  the  full 
developement  of  febrile  excitement.  Collapse  is  marked  by 
profuse  sweating,  shrivelled  hands,  a marble  coldness  of  the 
whole  surface,  the  pulse  imperceptible,  or  the  merest  thread 
frequently  receding  and  returning;  intense  thirst,  and  burn- 
ing heat  in  the  epigastrium.  The  respiration  is  slowly  per- 
formed, and  the  intervals  gradually  lengthen  as  the  patient 
sinks.  Spasms  occasionally  rouse  the  patient,  and  hurry  the 
performance  of  respiration,  which  at  times  is  convulsively 
performed.  The  tongue  is  moist,  cold  and  pale,  exhibiting 
scarcely  any  return  of  redness  after  being  pressed  with  the 
finger.  The  breath  is  cold  and  hot;  injections  are  soon  re- 
turned cold.  The  muscular  power  is  sometimes  entirely 
prostrated,  although  generally  it  is  retained  in  a remarkable 
degree,  enabling  the  patient  to  turn  in,  and  even  get  out  of 

3 


14 


Spencer  on  Asiatic  Cholera. 


bed.  The  intestinal  evacuations  generally  cease,  although  n 
passive  vomiting  or  involuhtary  stools  sometimes  continue 
to  the  last.  The  urinary  discharge  is  entirely  suspended. 
The  intellectual  function  is  in  numerous  instances  regularly, 
although  dully  performed  : reason  maintaining  her  empire  to 
the  last  moment.  A morbid  sensibility  of  the  surface  is  often 
present,  rendering  external  remedies  exceedingly  annoying 
to  the  patient.  The  voice  becomes  almost  extinct,  the  pa- 
tient confining  himself  to  the  feeble  and  plaintive  utterance 
of  the  single  word,  water.  Hiccup  is  an  occasional  symp- 
tom. Suffusion  or  ecchymosis  of  the  eyes  is  often  present, 
and  there  is  a waxy  inelastic  feel  of  the  skin,  which  when 
pinched  up,  remains  sometimes  in  that  position. 

Reaction. — If  the  system  rallies  from  this  low  condition, 
it  presents  some  diversity  in  the  train  of  symptoms,  which  re- 
quire to  be  noticed,  and  carefully  distinguished  from  the  con- 
secutive fever — a frequent  sequel  of  the  disease.  In  the 
most  favorable  cases  of  the  reaction,  the  skin  becomes  gradu- 
ally warmer  ; the  profuse  sweating  and  corrugation  of  hands 
subside  ; tire  breathing  becomes  more  full  and  free,  and  the 
system  progressively  and  uninterruptedly  returns  to  health 
and  vigor  : the  patient  who  has  apparently  been  in  the  lowest 
state  compatible  with  life,  being  able  soon  to  travel  about  the 
neighborhood.  But  this  favorable  progress  of  the  case  is  by 
no  means  generally  to  be  looked  for,  and  the  organs  of  the 
body  on  being  roused  from  this  state  of  semi-death,  are  thrown 
into  irregular  action,  the  carotids  beat  powerfully  ; the  heart 
throbs,  beating  at  times  irregularly  faster  or  slower,  or  its 
pulsation  is  felt  in  the  epigastrium.  The  pulse  is  sometimes 
full,  but  not  as  frequent  and  wiry  as  in  the  consecutive  fever. 
The  dreams,  if  the  patient  falls  asleep,  are  often  interrupted, 
and  he  awakes  as  if  from  sudden  fright.  Light  delirium  may 
come  on,  from  which  the  patient  can  readily  be  recalled  to 
consciousness.  In  this  condition,  the  tongue  generally  re- 
mains moist,  and  the  thirst  somewhat  urgent,  but  by  no  means 
as  intense  as  in  the  preceding  collapse,  or  in  the  consecutive 
fever.  The  respiration  sometimes  becomes  hurried,  and  is  ir- 
regularly performed,  accompanied  perhaps  by  sighing.  Throb- 


Spencer  on  Asiatic  Cholera • 


15 


bing  pains  are  sometimes  complained  of,  and  the  temporal 
arteries  are  found  beating  with  uncommon  force.  If  the  pa- 
tient appears  somewhat  comatose,  he  can  be  readily  roused. 
Quiet  sleep  sometimes  dissipates  this  perturbed  condition  of 
the  organs,  like  a charm.  The  skin  is  at  times  considerably 
warmer  than  natural,  but  does  not  produce  the  burning  sensa- 
tion to  the  hand  given  by  the  heat  of  the  consecutive  fever. 
This  state  of  reaction  strikingly  resembles  an  attack  of  ephe- 
meral fever,  in  which  the  agitated  condition  of  the  organs 
soon  resume  their  original  calmness. 

5.  Of  the  symptoms  of  the  fourth  stage. — This  has  been 
denominated  the  stage  of  consecutive  fever.  It  by  no  means 
uniformly  follows,  and  should  not  be  considered  as  constitut- 
ing an  essential  part  of  the  disease.  On  the  contrary,  it 
should  be  regarded  in  no  other  light  than  as  a fever  of  a low 
type,  liable  at  all  times  to  attack  the  system  after  hemorrha- 
ges, or  other  exhausting  discharges,  resulting  from  whatever 
cause,  in  enfeebled  conditions  of  the  system.  Although  re- 
garded in  this  light,  it  is  deemed  expedient  briefly  to  describe 
its  symptoms  with  a view  to  distinguish  it  from  the  reaction, 
and  to  establish  more  definitely  the  remediate  indications  in 
each.  The  tongue  becomes  loaded  with  a whitish  fur,  which 
soon  changes  to  a darker  colour,  and  brown  sordes  often 
collect  upon  the  teeth,  as  the  disease  advances.  The  edges 
and  tip  of  the  tongue  become  reddish,  and  a tremulous  motion 
is  often  observed  when  it  is  protruded.  In  the  reaction  the 
tongue  sometimes  becomes  covered  with  a thin  white  fur,  but 
the  vessels  of  the  edges  and  tip  are  by  no  means  as  much  in- 
jected as  in  fever.  The  headache  in  the  fever  is  more  steady 
than  in  the  reaction,  in  which  it  is  often  throbbing.  In  the 
reaction  the  headache  is  not  generally  such  as  to  interrupt 
the  motions  of  the  patient,  while  in  fever  the  indisposition  to 
motion  and  mental  exertion  is  a prominent  symptom.  The 
urine  in  this  fever,  is  in  many  cases  entirely  suspended,  and 
when  passed,  it  is  high  coloured  and  scanty.  The  pulse  is 
more  rapid,  small  and  hard  in  fever  than  in  reaction,  and  the 
eyes  are  more  suffused  and  drowsy.  In  the  progress  of  the 


16 


Spbmcer  on  Asiatic  Cholera. 


fever  a dull  expression  and  flush  of  the  countenance  come  on, 
resembling  in  a marked  degree  the  low  stage  of  common  ty- 
phus ; the  temperature  of  the  surface  changes,  and  the  skin 
from  being  hot  and  dry,  becomes  cooler  than  natural.  If  the 
head  becomes  the  seat  of  local  disease,  the  pain  is  generally 
fixed,  and  the  patient  appears  to  avoid  any  sudden  motion, 
while  consciousness  remains.  A delirium  or  coma  comes 
on,  from  either  of  which  the  patient  is  with  difficulty  roused, 
and  to  these  are  added  the  other  symptoms  usually  attendant 
upon  diseases  of  the  head.  Cough  and  difficulty  of  breathing, 
indicating  pneumonic  disease,  or  soreness  of  the  epigastrium 
and  abdomen,  with  other  symptoms  indicating  that  local  dis- 
ease of  the  abdominal  viscera  is  superadded  to  the  general 
fever,  often  make  their  appearance. 

6.  Of  the  prognosis. — The  danger  in  the  first  stage  is 
very  little  unless  the  remedies  are  improperly  delayed  or  un- 
skilfully employed.  In  every  part  of  the  disease  the  imme- 
diate danger  is  proportioned  to  the  extent  and  rapidity  of  the 
intestinal  discharges,  varied  only  by  the  constitution,  age, 
previous  habits,  and  idiosyncrasy  of  the  patient.  Cases  in 
which  the  diarrhoea  has  been  of  several  days’  continuance, 
are  always  more  dangerous  than  those  in  which  it  has  been  of 
short  duration,  previous  to  the  supervention  of  the  same  symp- 
toms. When  the  patient  continues  anxious  for  recovery, 
his  chance  is  better  than  when  he  is  indifferent  to  the  result. 
In  general,  when  active  vomiting  comes  on  early,  little  dan- 
ger needs  be  apprehended.  Broussais,  in  his  Lectures  re- 
marks, “ when  the  symptoms  predominate  in  the  upper  parts, 
and  the  diarrhoea  has  ceased,  I venture  the  opinion  that  the 
disease  is  more  easily  cured.”  When  free  warm  perspira- 
tion follows  vomiting,  and  especially  if  bilious  matter  ap- 
pears in  the  dejections,  the  patient  may  be  considered  safe. 
In  general,  patients  sink  more  rapidly  into  collapse  when 
spasms  are  absent  than  when  present.  Dr.  Kirk,  remarks 
that  “ when  the  spasms  cease,  I have  always  observed 
that  the  cases  are  most  incurable.”  Dr.  Scott  observes, 
(<  in  the  low  and  most  dangerous  form  of  cholera,  whether 


Spencer  on  Asiatic  Cholera. 


17 


European  or  native  cases,  spasm  is  generally  wanting, 
or  is  present  in  a very  slight  degree.*  In  the  collapse, 
the  symptoms  being  otherwise  alike,  those  cases  which  have 
come  on  suddenly  are  much  more  likely  to  recover  than  those 
which  advanced  slowly.  A profuse  perspiration,  shrivelled 
hands,  marble  coldness,  and  creeping  pulse,  denote  great 
danger.  If  the  passive  exhalation  of  the  skin  and  shrivelled 
hands  abate,  notwithstanding  the  skin  remains  cold,  and  the 
pulse  scarcely  if  at  all  perceptible,  considerable  hope  may 
be  entertained.  The  respiration  becoming  frequent  and  full, 
if  not  convulsive,  and  the  senses  remaining  clear,  are  favor- 
able omens.  We  should  never  despair,  while  the  powers  of 
breathing  and  swallowing  remain.  In  the  consecutive  fever 
great  danger  always  attends,  and  it  is  enhanced  by  the  pres- 
ence of  local  disease  in  proportion  to  the  importance  of  the 
organ  involved. 

7.  Dissections. — On  the  subject  of  dissections,  I cannot  lay 
elaim  to  much  knowledge  from  personal  experience,  having 
witnessed  but  one  post  mortem  examination — that  of  a colour- 
ed man,  who  died  in  the  Utica  cholera  hospital,  on  the  23d 
of  August  last.f  This  man  had  been  sick  about  four  days, 
reaction  had  been  in  some  measure  established  after  collapse, 
but  no  high  excitement  followed,  and  stimulants  had  been 
moderately  used.  No  urine  had  been  voided  since  collapse. 
The  brain  and  membranes  were  found  slightly  congested, 
and  there  was  considerable  serous  effusion  near  the  base  of 
the  brain  and  medulla  oblongata,  and  in  the  ventricbs.  In 
the  thorax  the  surface  of  the  lungs  was  beset  with  small  co- 
loured spots  of  a line  in  diameter.  The  cavities  of  the  heart 
were  filled  with  a dark  grumous  blood,  without  coagula.  In 
the  abdomen  the  peritoneal  covering  of  the  intestines  appear- 
ed slightly  injected.  The  liver  healthy,  except  a little  paler 
than  natural,  the  gall  bladder  filled  with  a dark  fluid,  nearly 
of  the  colour  but  of  thicker  consistence  than  the  blood  in  the 
cavities  of  the  heart.  The  large  vessels  of  the  liver  some- 

* Madras  Report. 

f Dissection  by  Dr.  Wall,  resident  physician. 


18 


Spencer  on  Asiatic  Cholera. 


what  filled.  Stomach. — Red  specks  of  the  size  of  millet 
seed  near  the  cardiac  orifice,  the  residue  white  as  natu- 
ral upon  the  inner  surface.  On  washing,  slight  specks  of  red 
appeared  occasionally  upon  the  intestinal  membrane,  but  gen- 
erally it  was  of  a natural  appearance.  The  bladder  con- 
tracted to  the  size  of  a pear,  from  one  quarter  to  three  eighths 
of  an  inch  thick.  Almost  all  the  internal  viscera  appeared 
rather  drained  than  filled  with  blood,  what  remained  bein°- 
in  the  veins  while  the  arteries  were  almost  entirely  empty. 
Some  bile  was  found  tinging  the  inner  surface  of  the  intes- 
tines for  a considerable  extent.  The  following  summary  of 
the  appearances  on  dissection  is  prepared  from  those  men- 
tioned by  the  various  writers  on  the  disease.  “ When  we 
examine  a corpse,  dead  of  cholera,  we  remark  a livid  pur- 
ple, or  blue  colour  of  the  skin,  over  the  whole  surface  of  the 
body,  but  more  strongly  marked  at  the  extremities  ; the  skin 
of  the  fingers  on  the  palmar  face  is  wrinkled,  and  the  tips  of 
the  fingers  and  toes  have  deep  furrows  within,  produced  by 
this  means.  The  eyes  are  deeply  sunken,  and  have  a dark 
bluish  black  ring  around  the  orbits,  the  conjunctiva  is  inject- 
ed with  blood,  and  has  a ghastly  lustre,  the  flexor  muscles 
are  rigidly  contracted,  the  tendons  standing  out  prominent 
on  the  extremities,  the  hands  are  firmly  clenched,  requiring 
an  effort  to  open  them.”* 

In  the  head,  various  appearances  are  mentioned  by  writers, 
such  as  the  brain  and  membranes  of  a healthy  aspect ; — con- 
gestions ; — serous  effusions. 

The  spinal  cord — healthy  ; loaded  with  blood  ; — soften- 
ed ; — slight  serous  effusions. 

Ganglionic  system — healthy  ; — ganglions  and  plexuses 
injected  with  blood. 

Thorax — lungs — natural ; gorged  with  dark  blood  ; — col- 
lapsed into  a small  hulk  ; — hepatized  after  reaction  ; — “ The 

* Boston  Metl.  Magazine,  for  Oct.  1833.  Taper  lay  Charles  T.  Jackson,  M.  D, 
“ on  Cholera  in  Vienna.” 


Spencer  on  Asiatic  Cholera. 


19 


pulmonary  veins  contain  clots  of  yellow  coagulated  lymph, 
tremulous  like  jelly.” 

Heart — structure  unchanged  ; — soft,  easily  torn  ; — left  ven- 
tricle and  aorta  at  times  distended  with  black  blood,  fluid  or 
coagulated. 

Abdomen — Omentum — healthy  ; — injected  with  blood. 
Mesentery , generally  filled  with  blood  ; — glands  occasionally 
enlarged.  Liver , generally  natural ; — paler  ; — engorged; — 
gall  bladder  filled  with  bile,  generally  dark,  occasionally  yel- 
low  : — “ all  the  branches  of  the  abdominal  portal  veins  were 
empty.”* 

Spleen , natural  ; — flaccid  ; occasionally  much  shrivelled. 

Bladder , contracted  and  empty  ; — rarely  filled. 

Stomach- — external  membranes  sometimes  natural,  frequent- 
ly reddened ; — internal  membrane  healthy  ; — paler  than  nat- 
ural after  death  in  collapse  ; — red  specks  ; rounded  vesicles 
containing  pus  ; — streaks  of  red  ; — red  patches  ; — delicate 
pink  colour ; — granulated  ; — thickened  ; — softened ; — friable  ; 
— arterial  engorgement ; — venous  engorgement ; — dark  colour 
after  fever ; — sphacelus  ; — contents,  ingesta  unaltered ; — flu- 
ids transparent  green,  dark,  flaky  ; — coagulable  lymph  ; — 
bloody  gelatine. 

Intestines — external  membrane  occasionally  healthy  ; — 
generally  injected  with  blood.  Internal  membrane — natural 
colour ; — paler  than  usual  when  they  suddenly  die  in  col- 
lapse ; — specks  of  red  ; — red  patches  ; — vermilion  colour ; — 
pink  colour ; — diffused  redness  ; — dark  colour  ; — rarely  dis- 
organization ; — softening  of  mucous  membrane.  PeyePs 
and  Brunner's  glands , at  times  natural  or  prominent  on 
pale  membrane,  with  occasional  black  points  at  centre  ; — 
rarely  ulcerated  ; — introsusceptions  ; — valvulae  conniventes 
flaccid,  thickened  and  swollen.  Contents — air,  serous  fluids 
of  various  colours,  whitish,  oftenest  red  after  collapse,  and 

yellow  after  reaction  ; flocculte  ; — adherent,  whitish  or 

greenish  mucus ; — foecal  matter  and  bile  in  the  large  intes- 
tines, about  in  live  of  one  hundred  cases. 


* Amcr.  Journal,  Nor.  1332,  p.  225.  Earlv  Dissections  at  Paris. 


20 


Spencer  on  Asiatic  Cholera. 


Serous  membranes , healthy  ; — drier  than  natural ; blanch-' 
ed  appearance  ; — slight  turgidity  and  blueness. 

It  appears  to  be  a pretty  generally  conceded  point,  among 
medical  men,  throughout  the  globe,  that  little  is  to  be  learn- 
ed from  dissections  in  this  disease ; the  integrity  of  every 
organ  remaining  entire,  when  death  ensues  suddenly  in  the 
collapse.  Dr.  Winslow  remarks,  that  “ in  the  examination  of 
the  few  cases  submitted  to  dissection,  no  changes  have  been 
discovered  adequate  to  the  alarming  nature  of  the  symptoms.” 
From  the  summary  made  of  the  various  appearances  on  dis- 
section, it  would  seem  that  no  organ  is  uniformly  congested  or 
inflamed,  and  that  these  appearances  are  at  times  found  in 
many  organs  or  tissues.  It  may,  however,  be  observed,  that 
congestion  or  inflammatory  appearances  are  much  the  most 
frequently  found  in  the  alimentary  canal.  The  stomach 
is  in  such  diversified  conditions  in  this,  as  well  as  numerous 
other  diseases,  that  medical  reasonings,  founded  upon  any 
change  of  appearances  in  this  organ,  must  be  considered  ex- 
ceedingly uncertain.  The  alterations  observable  in  all  the 
organs  appear  greatly  influenced  by  the  period  of  the  disease 
at  which  death  takes  place.  Cases  that  progress  slowly, 
exhibit  the  greatest  changes  from  the  normal  appearance. 

Of  the  changes  in  the  blood. — The  blood  becomes  exceed- 
ingly dark  coloured  as  the  disease  advances  to  the  stage  of  col- 
lapse, and  chemical  analysis  has  proved  that  this  fluid  is  great- 
ly changed  in  the  relative  proportions  of  its  ingredients,  com- 
pared with  the  healthy  standard.  Its  specific  gravity  is  in- 
creased, but  its  most  remarkable  change  is  in  the  great  dimi- 
nution of  the  fluid  ingredients.  The  crassimentum  is  more 
than  twice  as  much,  as  in  healthy  blood,  while  the  serum  is 
proportionably  diminished.*  There  is  an  absence  of  the  alka- 
line carbonate,  and  a great  deficiency  of  the  saline  materials 
usually  found  in  healthy  blood.  The  fibrin  is  likewise  great, 
ly  diminished.  The  intestinal  evacuations  have  been  found 
upon  chemical  analysis  to  contain  the  same  ingredients  which 


* Professor  Thomson,  of  Edinburgh. 


Spencer  on  Asiatic  Cholera. 


21 


were  found  deficient  in  the  blood.*  There  is  some  discrepan- 
cy in  the  results  as  detailed  by  different  individuals,  but  in 
the  general  summary  above  stated,  it  is  believed  a coinci- 
dence may  be  found. 


CHAPTER  11. 

DIVISION  OF  THE  SYMPTOMS  INTO  CONSTANT  AND  OCCA- 
SIONAL. 

1.  Of  the  constant  symptoms. — In  the  preceding  chapter, 
£l  general  summary  of  the  causes,  phenomena  and  sequences 
of  this  epidemic  has  been  attempted,  with  a view  to  make  it 
the  basis  of  reasoning  on  the  pathology  of  the  disease.  But 
before  commencing  with  this,  a preliminary  inquiry  is  re- 
quired into  what  may  be  considered  as  constant,  and  what 
accidental  circumstances  in  relation  to  the  disease.  On  the 
causes,  there  is  so  general  a coincidence  of  opinion  among 
medical  men,  that  no  comment  is  necessary.  On  the  symptoms , 
this  remark  cannot  be  made  to  the  same  unlimited  extent ; 
yet  at  the  present  time  no  great  diversity  of  opinion  appears 
to  exist.  A white,  slimy  tongue  generally  precedes  the  at- 
tacks of  this  disease.  The  attention  of  the  public  was  di- 
rected to  this  symptom,  by  Dr.  James  M‘Naughton,  in  a pa- 
per published  in  August  last,  “ On  the  Epidemic  Cholera  of 
Albany.”  Distress  at  the  pit  of  the  stomach  and  indigestion, 
it  is  thought  uniformly  precede  or  accompany  the  attacks. 
Intestinal  discharges , with  the  symptoms  mentioned,  consti- 
tute the  leading  and  most  uniform  phenomena  in  the  early 
stage.  Indeed,  diarrhoea  in  a vast  proportion  of  cases  com- 
mences the  disease,  and  continues  until  the  patient  is  in 
collapse,  and  occasionally  until  death.  This,  then,  must  be 
regarded  as  an  essential  and  characteristic  symptom  through' 

* Paine. 

4 

I 


22 


Spencer  on  Asiatic  Cholera. 


out.  Dr.  Kirk,  of  Greenock,  first  directed  the  public  atten- 
tion to  the  important  point  that  diarrhoea  uniformly  preceded 
all  severe  attacks  which  occurred  on  the  island  of  Great 
Britain.  Dr.  Isaac  Hays  remarks,*  “ that  this  symptom  is 
rarely  altogether  absent,  though  it  unquestionably  is  so  oc- 
casionally, and  when  this  is  the  case,  it  appears  to  denote  a 
peculiar  malignancy  in  the  attack.  In  cases  where  little  or 
no  purging  has  taken  place  during  life,  the  intestines  have  yet 
been  found  after  death  to  be  filled  with  rice-water  like  mat- 
ter.” During  the  prevalence  of  all  great  epidemics,  cases 
occur  in  which  life  is  extinguished  without  the  developement 
of  the  symptoms  usually  characterizing  the  disease.  The 
concurrent  testimony  of  the  profession  in  this  country  seems 
to  confirm  the  fact  of  the  almost  universal  precedence  of  the 
diarrhoea  in  the  severe  attacks.  Professor  Sewall,  of  Wash- 
ington, however  writes  me,  that  “ generally  the  cholera  was 
preceded  by  diarrhoea,  but  there  were  exceptions  to  this.” 
But  Dr.  Kirk  spoke  of  diarrhoea  as  one  of  an  uncertain  set 
of  phenomena,  which  he  denominated  “ premonitory  symp- 
toms''’ and  which  the  French  physicians  called  “ cholerine ,” 
and  the  disease  crossed  the  Atlantic  veiled  in  mystery.  Its 
masked  character  greatly  heightened  the  general  panic — a 
concealed  and  covert  enemy  being  always  much  more  ter- 
rific, than  he  who  meets  us  in  open,  manly  combat.  In 
thus  speaking,  I would  not  have  it  understood,  that  I do  not 
duly  appreciate  the  labors  of  Dr.  Kirk  ; on  the  contrary,  his 
indefatigable  research  in  establishing  this  important  fact,  has 
done  more  than  almost  any  thing  else  in  unravelling  the  mys- 
teries, and  destroying  the  terrors  of  this  disease.  Dr.  Kirk, 
however,  calls  this  “ diarrhoea  cholerica and  intimates  the 
belief  that  this  might  be  contagious,  and  be  the  medium  of  the 
rapid  dissemination  of  this  epidemic  throughout  the  globe. 
It  became  a matter,  therefore,  of  interesting  inquiry,  what 
symptoms  would  distinguish  this  from  common  diarrhoea , 

* American  Journal  Medical  Sciences,  Feb.  1S33,  which  he  obligingly  allowed 
me  to  read  in  proof. 


Spencer  on  Asiatic  Cholera. 


23 


which  never  had  been  considered  contagious.  With  a view 
to  determine  this  point  previous  to  having  an  opportunity  of 
personally  observing  the  disease,  I addressed  letters  to  sever- 
al medical  gentlemen,  living  in  places  where  it  had  prevail- 
ed, and  requested  an  answer  to  the  following  among  other  en- 
quiries : Are  there  any  symptoms  to  distinguish  the  diarrhoea 
which  precedes  cholera , from  the  ordinary  diarrhoea  ? This 
was  proposed  with  a view  to  a more  definite  diagnosis  of  the 
disease,  in  its  first  approaches,  and  in  the  expectation  that  the 
line  of  demarcation  might  be  drawn  between  the  common  and 
“ diarrhoea  cholericaf  and  thereby  community  be  put  in  pos- 
session of  the  means  of  detecting  its  early  onset.  In  a high- 
ly interesting  communication  from  the  late  Dr.  Jonathan 
Day,  of  Syracuse,  previous  to  his  falling  a victim  to  the  epi- 
demic, I received  as  answer  to  the  above  enquiry : “ The 
diarrhoea  that  precedes  cholera  is  much  like  that  described 
by  Dr.  Good,  as  diarrhoea  serosa.  As  I have  never  before 
thought  diarrhoea  of  sufficient  importance  to  make  much  dis- 
crimination in  its  varieties,  I am  not  able  to  say  whether  it 
differs  materially  in  its  symptoms  from  the  ordinary  disease.” 
In  answer  to  a like  inquiry,  Dr.  M‘Naughton,  in  his  paper 
already  noticed,  says,  u I know  of  no  circumstance  which 
distinguishes  the  diarrhoea,  which  precedes  the  cholera,  from 
ordinary  diarrhoea,  unless  it  be  the  total  absence  of  biliary  se- 
cretion in  the  discharges.  Bile,  I believe,  is  never  present 
in  the  discharges  preceding  an  attack  of  malignant  cholera. 
If  bile  be  found  in  the  dejection,  the  cholera  will  be  found  of 
the  common  kind,  should  it  follow  a diarrhoea.”  On  person- 
ally observing  the  disease,  the  remark  of  Dr.  M‘Naughton 
was  fully  confirmed,  not  only  as  to  the  cases  preceding  the 
attacks  of  the  11  cholera,”  but  the  universal  diarrhoea  which 
prevailed  was  found  to  be  of  the  same  general  character.  On 
enquiry  of  my  professional  neighbours,  Dr.  Knowlton  of 
Cazenovia,  and  Dr.  Mead  of  Nelson,  who  resided  in  villages 
where  the  severe  grades  of  the  epidemic  did  not  occur,  it  was 
ascertained  that  watery  or  milky  diarrhoea  had  extensivelv 


24 


Spencer  on  Asiatic  Cholera. 


prevailed,  devoid  of  biliary  admixture.  In  answer  to  a letter 
of  enquiry.  Dr.  Henry  Mitchell,  of  Norwich,  where  the  se- 
vere grades  of  the  epidemic  did  not  appear,  remarks,  “ di- 
arrhoeas have  been  much  more  frequent  during  the  past  sum- 
mer than  I have  ever  known  them  before  ; they  were  almost 
wholly  watery , and  the  functions  of  the  liver  apparently  sus- 
pended.”  Other  letters  from  various  gentlemen  throughout 
the  United  States,  confirm  the  same  fact.  The  disease  seems 
to  have  attacked  in  its  mild  form  the  inmates  of  various  pub- 
lic establishments,  among  which  I may  mention  the  “ house 
of  industry,”  in  Boston,  and  the  Massachusetts  state  prison, 
in  both  of  which  places,  intestinal  diseases  of  a mysterious 
character,  simultaneously  made  their  appearance,  but  death 
being  regarded  as  a necessary  symptom  of  cholera,  it  was  con- 
cluded they  could  not  be  cases  of  the  epidemic.  In  the  Au- 
burn state  prison  report  for  August,  to  Gov.  Throop,  made 
by  Dr.  John  G.  Morgan,  a large  proportion  of  the  cases  of 
diseases  reported  were  “ diarrhoea  serosa ,”  many  of  which 
assumed  a severe  character,  but  the  prompt  and  efficient 
means  employed,  rescued  the  inmates  from  danger.  It  is  be- 
lieved that  the  assertion  may  be  ventured,  that  the  almost  uni- 
versal diarrhoea  throughout  the  United  States,  has  been  se- 
rous, and  devoid  of  bile  in  the  dejections. 

Sharpened  and  emaciated  expression  of  countenance , pros- 
tration of  strength , indisposition  to  corporeal  and  mental  ex- 
ertion, are  uniform  symptoms  throughout,  varying  according 
to  the  intensity  and  stage  of  the  disease.  In  the  second  stage 
we  have  added  to  the  above  list  of  symptoms,  constantly  di- 
minishing force  of  the  pulse,  scanty  or  suspended  urine,  and 
thirst  more  or  less  urgent,  according  to  the  rapidity  and  vio- 
lence of  the  disease.  Abdominal  pain,  frequently  very  slight, 
may  be  mentioned  among  the  symptoms  constantly  attending. 
A purple  or  dusky  brown  appearance  of  the  skin , marble 
coldness,  low  wail  of  voice,  corrugations  of  the  hands,  when 
profuse  sweating  is  present , may  be  enumerated  as  uniform 
symptoms  of  the  collapse.  These  are  symptoms  character- 
ising the  last  stage  of  numerous  diseases.  Corrugations  of 


Spencer  on  Asiatic  Cholera. 


25 


-the  hands  have  been  much  dwelt  upon  as  a characteristic 
symptom  of  this  epidemic;  but  Professor  Dewees  of  the  Uni- 
versity of  Philadelphia,  mentions  it  as  a symptom  of  the  col- 
lapse of  hemorrhage.  Dr.  Nathan  Smith,  in  his  practical  es- 
say on  typhus,  remarks,  “ in  fatal  cases  there  sometimes  ap- 
pears what  has  been  called  the  washer-woman’ s sweat — 
which  is  extremely  profuse,  over  the  whole  surface  of  the 
body  and  extremities,  standing  in  large  drops  on  the  face,  and 
giving  to  the  cuticle  on  the  palms  of  the  hands  and  soles  of 
the  feet  a corrugated  appearance,  and  a light  colour  as  if  it 
had  long  been  macerated  in  water.”  I believe  that  this  symp- 
tom is  generally  present  in  all  cases  of  profuse  sweating,  but 
it  may  result  in  some  measure  from  the  rapid  absorption  in  the 
disease  under  consideration.  Passive  exudation  from  the  skin, 
cold  tongue , cold  breath,  and  hot  injections  coming  away  cold , 
are  present  in  collapse,  but  absent  in  all  the  other  stages.  Al- 
though the  cold  tongue  and  cold  breath  have  been  much 
dwelt  upon  as  distinguishing  symptoms  of  the  epidemic,  yet 
the  opinion  is  ventured,  that  these  may  be  found  in  the  col- 
lapse of  all  diseases. 

2.  Of  the  occasional  symptoms. — Among  the  symptoms 
frequently  present  in  the  first  stage,  may  be  mentioned  dry- 
ness of  the  surface , cold  clammy  feel  of  the  extremities , and  a 
great  commotion  and  rumbling  of  the  bowels.  But,  the  most 
prominent  of  the  occasional  symptoms,  are  vomiting  and 
spasms , "which  have  been  much  dwelt  upon  by  medical  wri- 
ters, as  among  the  distinguishing  symptoms  ; so  much  so,  that 
their  frequent  absence  in  cases  submitted  to  my  personal  ob- 
servation, alone  satisfied  me  that  they  should  be  considered 
in  the  light  of  accidental  phenomena.  In  addition  to  those  oc- 
curring under  my  own  prescription,  an  opportunity  present- 
ed of  observing  the  same  in  the  case  of  Mrs.  Snow,  of  Utica, 
under  the  care  of  Drs.  Van  Zandt  and  Coventry,  w-ho  had 
witnessed  considerable  of  the  disease,  not  only  in  their  own 
city,  but  while  on  a tour  of  observation  to  Albany  and  New- 
York.  In  this  case  I was  informed,  that  a gallon  of  fluid  was 
discharged  every  fifteen  minutes,  until  collapse  supervened, 


26 


Spencer  on  Asiatic  Cholera. 


and  yet  vomiting  and  spasms  were  entirely  absent.*  There 
is  this  marked  difference  between  vomiting  and  purging  as 
symptoms,  that  the  first  is  confined  generally  to  one  stage  of 
the  disease,  while  diarrhoea  is  prominent  in  all  its  essential 
stages.  A still  farther  difference  is  the  frequent  absence 
of  vomiting.  How  often  it  does  occur,  it  would  be  ex- 
ceedingly difficult  to  estimate,  until  medical  men  draw  the 
line  between  the  preceding  diarrhoea  and  cholera.  The  re- 
port of  cases  in  public  hospitals,  where  faithful  records  have 
been  kept,  shows  different  results.  In  one  of  the  Philadelphia 
hospitals,  a record  kept  by  Dr.  Samuel  Jackson,  shows  12  in 
21  cases,  where  vomiting  was  a symptom,  and  in  10  of  these 
there  were  spasms.  In  a record  of  60  cases  kept  in  the  hos- 
pital “ La  Pitie,”  by  James  Jackson,  Jr.  vomiting  was  absent 
in  two  cases,  and  cramps  in  five.  Dr.  Isaac  Hays,  in  the 
American  Journalf  remarks,  a that  vomiting  is  a prominent 
symptom  in  cholera,  but  there  are  numerous  instances  in 
which  it  is  entirely  absent.  According  to  Mr.  Scott,  in  cer- 
tain visitations  in  India,  there  was  scarcely  an  individual  case 
in  which  it  was  manifested  and  Mr.  Pinel  asserts  that  in 
Poland  it  was  absent  in  three-fifths  of  the  cases. § In  Paris, 
London  and  this  country,  this  symptom  has  been  observed  to 
be  pretty  constantly  present.” 

Vomiting  is  a frequent  symptom  in  influenza  and  dysente- 
ry, when  these  diseases  prevail  epidemically  ; although  usual- 
ly absent  when  cases  are  sporadic.  Indeed,  scarcely  a disease 
exists  of  any  severity,  but  that  vomiting  is  present,  or  the 
stomach  becomes  more  or  less  disordered ; and  this  organ 
seems  to  be  the  centre  of  that  infinite  play  of  sympathies  by 
which  the  balance  is  preserved  among  the  viscera  of  organic 

* Marcellus  Donatus  has  narrated  particulars  relative  to  a woman  in  whom  syn- 
cope was  occasioned  by  the  excessive  serous  excretion.  So  copious  was  the  evacu- 
tion  that  a large  vessel  was  filled  at  one  dejection.  Poterius  mentions  a notary, 
who,  within  one  day,  voided  upwards  of  forty  pints  of  serous  matter,  and  it  nearly 
proved  fatal  to  him. — Cooke's  Morgagni,  vol.  ii.  105. 

Must  not  the  serous  discharges  in  this  epidemic  come  from  the  same  source  as  in 
the  cases  of  serous  diarrhoea,  alluded  to  and  related  by  Morgagni?  Or,  has  the  or- 
ganization of  the  intestines  changed  since  his  time  ? 
j For  February  1833. 
j Madras  Report. 


§ Gaz.  Med.  de  Paris,  iii,  102. 


Spencer  on  Asiatic  Cholera. 


27 


life,  and  by  which  the  operations  of  nature  are  so  skilfully  di- 
rected in  their  efforts  to  throw  off  disease.  It  hence  appears, 
that  vomiting  may  be  properly  classed  among  the  accidental 
phenomena  of  this  epidemic.  Spasms  are  more  frequently  ab- 
sent than  vomiting,  but  more  indiscriminately  attack  all  sta- 
ges, although  generally  occurring  even  later  in  the  disease. 
Rice-coloured  evacuations  have  been  much  dwelt  upon  as- 
characteristic,  but  those  who  think  this  peculiar  to  the  epi- 
demic must  have  overlooked  the  appearance  in  other  intesti- 
nal diseases.  Although  serum  is  uniformly  present,  its  co- 
lour is  wholly  accidental.  A urinous  smell  of  the  intestinal 
discharges  does  not  appear  to  have  been  much  noticed  by  wri- 
ters, but  Dr.  Shipman  mentions  his  having  frequently  observ- 
ed it,  and  that  his  attention  was  first  directed  to  it  by  the  late 
Dr.  Day,  of  Syracuse.  Dr.  Jonathan  Eights  mentions  its 
presence  in  the  disease  at  Albany.  To  the  occasional  symp- 
toms enumerated  may  be  added  dizziness,  deafness , dysuria, 
various  alterations  of  breathing,  chills , gripings  and  convul- 
sions. Among  this  class  may  likewise  be  noticed  one  which 
from  its  being  generally  present,  might  almost  be  arranged 
among  the  uniform  symptoms,  the  entire  retention  of  the 
mental  faculties.  Although  a dullness  of  perception  is  gen- 
erally observable,  yet  cases  occur  in  which  there  is  such  a 
retention  of  the  intellectual  energy,  in  the  last  moments  of 
life  as  to  manifest  the  independence  upon  material  organiza- 
tion of  that  immortal  part  destined  to  endure  when  “ time 
shall  be  no  longer.” 


CHAPTER  III. 

OF  THE  PATHOLOGY  OF  THE  FIRST  STAGE. 

1.  General  remarks  on  epidemics  and  their  laws. — Hav- 
ing described  the  disease,  and  distinguished  the  symptoms 
into  constant  and  occasional,  it  is  now  proposed  to  enter  upon 
an  analytical  examination  of  its  essential  phenomena,  and 
trace  their  relations  to  the  causes  of  the  malady,  and  by  that 


28 


Spencer  on  Asiatic  Cholerct. 


means  endeavor  to  arrive  at  its  essential  seat  and  nature/ 
The  first  question  which  suggests  itself  in  commencing  our 
enquiries  is,  what  is  the  original  cause  of  the  epidemics  which 
become  such  wide  destroyers  of  the  human  race  ? The  first 
moving  causes  of  all  the  phenomena  of  universal  nature  are 
denied  to  the  comprehension  of  the  human  understanding, 
and  belong  alone  to  Him,  who  said  “ let  there  be  light,  and 
there  was  light.”  To  man  is  given  the  humbler  task  of  ob- 
serving such  phenomena,  the  laws  of  which  become  the  le- 
gitimate objects  of  philosophical  enquiry.  Notwithstanding 
the  most  indefatigable  exercise  of  human  ingenuity,  the  ma- 
terial substance,  if  such  it  be,  has  thus  far  eluded  our  re- 
search, and  may  never  be  subjected  to  the  examination  of  our 
senses.  Perhaps  the  supposition  of  some  generally  diffused 
substances  producing  these  diseases,  has  led  us  to  overlook  the 
changes  which  have  taken  place  in  some  of  the  elements 
which  constantly  surround  us,  and  which  have  been  subjected 
to  the  examination  of  our  sensitive  organs.  Much  time  has 
likewise  been  spent  in  discussing  the  question  whether  this 
general  cause  is  animalcular,  electric,  atmospheric,  or  tellu- 
ric. If  it  could  be  proved  to  be  animalcular,  it  would  be  ex- 
ceedingly difficult  for  human  ingenuity  to  devise  the  means 
of  destroying  that  wide  spread  microscopic  race.  If  telluric, 
it  must  operate  at  intervals  through  the  medium  of  our  food 
or  drinks,  or  it  must  be  an  exhalation  from  the  earth,  mixing 
with  the  air,  and  become  atmospheric  at  last.  It  seems  of 
little  consequence  to  determine  this  question,  so  long  as  the 
cause  eludes  our  examination  ; and  indeed  even  then  we 
should  be  unable  to  remedy  the  evil,  throughout  the  immeas- 
urable tracts  of  country,  over  which  epidemics  simultaneous- 
ly spread  devastation.  Much  discussion  has  likewise  been 
indulged  in  relation  to  the  particular  manner  in  which  mala- 
ria, or  the  epidemic  influenza  produces  its  effects  upon  the  con- 
stitution. By  some,  it  is  strenuously  contended  that  its  pri- 
mary action  is  upon  the  stomach,  first  mixing  with  the  sali- 
va. Others  insist  that  it  is  received  through  the  medium  of 
the  lungs  ; or  that  it  merely  prevents  the  usual  supply  of  oxy- 


Spencer  on  Asiatic  Cholera.  29 

gen  for  the  arterializalion  of  the  blood.  The  nerves  of  the 
nose  are  supposed  by  some  to  be  the  parts  on  which  the  im- 
pression is  first  made,  and  communicated  by  sympathy  to  the 
brain,  and  from  thence  reflected  upon  other  organs ; or  the 
skin  is  the  part  on  which  it  is  believed  that  the  cause  first 
impresses  its  influence.  In  the  attacks  of  all  epidemics,  the 
stomach  gives  early  notice  of  disordered  function  by  the  usual 
symptom  of  indigestion.  The  brain  likewise  exhibits  evi- 
dence of  disorder  by  languor  and  indisposition  to  corporeal 
and  mental  exertion.  The  brain  and  stomach,  which  seem  to 
be  the  centres  of  the  two  systems  of  animal  and  organic 
life,  and  which  are  constantly  and  reciprocally  dependent 
upon  each  other  for  existence,  so  far  as  is  yet  determined, 
simultaneously  give  notice  of  derangement.  These  are  un- 
doubtedly interesting  fields  of  inquiry,  and  the  efforts  made  to 
support  the  respective  theories,  have  been  the  means  of  de- 
veloping many  valuable  facts  ; but  too  little  appears  as  yet 
known  upon  this  subject  to  make  any  of  these  doctrines  the 
basis  of  medical  reasoning.  In  prosecuting  our  enquiries,  it 
is  believed  of  little  consequence  to  determine  whether  the 
brain  or  stomach  is  primarily  affected.  At  present,  it  is  best 
to  confess  our  ignorance,  and  confine  ourselves  to  the  careful 
observance  of  the  effects  resulting  from  these  intangible 
causes. 

The  accumulated  observation  of  ages  has  established  the 
position,  that  epidemic  diseases  are  all  governed  by  some  gen- 
eral laws,  to  which  it  may  be  well  briefly  to  recur  in  prose- 
cuting our  enquiries.  The  epidemic  influence  appears  to  be 
generally  thrown  upon  some  particular  tissue  or  organ,  giv- 
ing it  a predisposition , so  that  slight  causes  will  often  excite 
this  tissue  into  violent  disease.  This  may  be  exemplified  by 
a reference  to  influenza,  which  in  its  sporadic  form  of  catarrh, 
excites  little  apprehension,  calling  for  scarce  a medicine, 
but  on  becoming  epidemic,  produces  such  a predisposition  in 
the  mucous  membrane  of  the  air  passages  of  the  lungs,  that 
every  member  of  the  community  is  liable  from  the  slightest 
exposure  to  cold,  or  other  exciting  causes,  to  have  the  dis- 

5 


30 


Spencer  on  Asiatic  Cholera . 


ease  developed,  and  it  now  comes  to  assume  a serious  charac- 
ter, demanding  the  vigorous  resources  of  the  healing  art. 
This  remark  is  likewise  applicable  to  all  epidemics,  which 
become  much  more  severe  than  in  their  ordinary  sporadic 
form.  In  dysentery,  this  general  predisposition  is  produced 
upon  the  mucous  membrane  of  the  colon,  and  during  its 
prevalence,  the  same  causes  which  excite  influenza,  when 
that  is  epidemic,  now  act  by  producing  dysentery.  The 
same  remark  holds  in  relation  to  typhus  or  intermittent  fe- 
vers, where  they  prevail  as  epidemics  or  endemics.  During 
the  continuance  of  that  particular  constitution  of  atmosphere 
which  produces  this  appetency  to  either  of  these  diseases,  ex- 
citing causes,  which  under  ordinary  conditions  of  the  system, 
might  be  applied  with  impunity,  will  produce  the  severe  at- 
tacks. Diseases  are  innumerable,  but  the  excitinc  causes  are 
few.  Sudden  exposure  to  cold,  for  instance,  is  an  exciting 
cause  of  a host  of  maladies,  and  under  ordinary  conditions  of  the 
system  produces  disease  wherever  particular  predisposition  or 
accident  locates  it.  But  if  this  general  predisposition  is  dis- 
seminated throughout  the  community,  these  causes  are  invit- 
ed to  be  expanded  upon  the  susceptible  organ,  and  hence  we 
have  that  general  law,  that  epidemics  chase  off  other  diseas- 
es. Dr.  Rush,  and  others,  have  remarked,  that  during  the 
prevalence  of  epidemics , all  diseases  partake  more  or  less  of 
their  nature.  This  circumstance  we  should  expect,  since 
every  malady  producing  general  commotion  of  the  complicat- 
ed machinery  of  life,  would  be  likely  to  develope  disease  in 
some  degree,  in  the  generally  predisposed  organ  remote  from 
the  seat  of  the  first  complaint.  In  individuals  who  have  suf- 
fered repeated  attacks  of  any  malady,  in  a particular  organ, 
this  becomes  the  subsequent  seat  of  predisposition,  and  the 
usual  exciters  of  disease  expend  their  influence  more  general- 
ly upon  that  part  than  any  other.  But  if  fever,  or  anv  gener- 
al disease  attacks  this  individual,  the  predisposed  organ  is  ex- 
ceedingly apt  to  suffer.  It  will  thus  appear,  that  epidemics 
are  governed  by  the  same  laws  observable  in  individual  cas^ 
gs  of  predisposition. 


Spencer  on  Asiatic  Cholera. 


31 


2.  Of  the  modus  operandi  of  the  epidemic  influence. — On 
the  appearance  of  every  epidemic,  the  first  object  of  enquiry 
should  be,  on  what  organ  or  tissue  this  general  predisposition 
is  thrown.  At  what  period  of  the  disease  can  this  last  be 
ascertained  ? In  the  early  stage,  when  the  symptoms  are  few, 
and  easily  considered,  or  at  the  advanced  period,  when  all  the 
organs  of  the  body  are  drawn  into  the  disease,  and  a numer- 
ous train  of  symptoms  are  to  be  taken  into  the  account  ? 
Most  assuredly  the  former ; since  as  the  complaint  advances, 
it  becomes  at  times  exceedingly  difficult  to  say,  whether  a 
phenomenon  results  from  the  original  disease,  or  from  the  dis- 
turbance of  some  part  secondarily  drawn  into  the  general 
commotion  of  the  organs,  which  obtains  in  the  aggravated 
stage  of  severe  maladies.  The  cause  of  the  present  epidem- 
ic must  be  generally  and  extensively  diffused,  since  almost 
every  person  in  the  community  was  afflicted  more  or  less  dur- 
ing its  continuance,  with  distress  and  faintness  at  the  pit  of  the 
stomach  and  diarrhoea,  even  when  it  has  not  assumed  a severe 
and  malignant  character.  The  first  observable  effects  are 
found  in  the  digestive  apparatus,  particularly  the  stomach, 
in  which  food,  drinks , and  even  wine , remain  many  hours  un- 
changed. From  this  it  may  be  conclusively  inferred,  that  the 
stomach  is  weakened  and  disordered,  in  its  function,  and  an- 
other proof  may  be  found  in  the  white  slimy  tongue,  a gener- 
ally admitted  evidence  of  gastric  derangement.  This,  how- 
ever, occurs  in  most  epidemics,  and  the  stomach  participates 
in  the  diseases  of  so  many  other  parts  that  the  enquiry  natur- 
ally arises,  whether  it  is  in  this  instance  the  seat  of  predispo- 
sition, or  responds  to  some  other  organ  with  which  it  is  sympa- 
thetically associated.  The  next  symptom  which  becomes 
developed,  and  which  at  times  makes  its  appearance  simul- 
taneously, is  a milky  or  watery  diarrhoea,  often  without  any 
mark  of  pain,  except  distress  at  the  stomach.  What  are  we 
to  infer  from  this  milky  appearance?  The  small  intestines  are 
the  parts  where  the  food  is  received  after  being  digested  by 
the  stomach,  and  taken  up  by  the  lacteal  and  carried  into  the 
circulation.  We  may  conclude  that  the  chyle,  instead  of 


32 


Spencer  on  Asiatic  Cholera. 


being  carried  into  the  bloud  vessels  is  discharged  by  the  in- 
testinal outlet,  giving  to  the  evacuations  a milky  aspect.  The 
food  undergoes  changes  likewise  by  mixing  with  the  secre- 
tions of  the  intestinal  membranes,  and  with  the  exhalation 
which  dilutes  and  prepares  it  for  the  lacteals,  and  the  serum 
of  the  discharge  mixed  with  the  chyle,  or  appearing  in  the 
form  of  this  watery  diarrhoea,  must  come  from  the  intestinal 
exhalents.  The  liver  is  the  next  organ  which  gives  evidence 
of  disorder.  Pain  in  the  right  side,  in  the  shoulder,  and 
the  other  symptoms  indicating  inflammatory  disease,  are  all 
wanting.  A negative  symptom  alone,  absence  of  bile  in  the 
evacuations,  indicates  an  interrupted  function  of  the  liver, 
and  there  being  no  evidence  of  organic  disease,  we  must  be- 
lieve that  it  results  from  torpor,  obstructed  duct,  or  that  the  ma- 
terials from  which  the  bile  is  manufactured,  are  cut  oflf. 
Spasm  of  the  gall  ducts  has  been  supposed  by  some  to  pro- 
duce this  result,  but  the  absence  of  spasms  sufficiently  dis- 
proves this  position.  If  not,  we  must  suppose  it  often  exists 
several  days  in  this  stage  of  predisposition.  If  it  did  exist, 
and  the  bile  was  continually  secreted,  the  absorbents  being 
always  active,  would  carry  the  bile  into  the  blood  vessels, 
which  would  in  the  round  of  circulation,  give  a yellow  tinge 
to  the  skin,  a circumstance  which  does  not  occur.  The 
source  of  this  symptom  admits  of  a ready  explanation,  from 
the  established  laws  of  physiology,  in  the  sympathetic  rela- 
tions which  exist  between  the  several  organs  concerned  in  di- 
gestion. In  health  the  liver  always  responds  to  the  stomach, 
acting  vigorously  while  digestion  of  the  food  is  proceeding, 
preparing  the  bile  to  mix  with  the  chyme  in  the  small  intes- 
tines. When  the  stomach  is  empty,  the  liver  falls  into  a 
comparative  state  of  quiescence,  secreting  but  a moderate 
quantity.  The  function  of  the  stomach  in  this  disease,  being 
nearly  suspended,  if  the  liver  observed  its  habitual  actions, 
the  secretion  of  bile  would  cease.  We  may  from  all  this  in- 
fer that  there  is  no  mechanical  obstruction  to  the  discharge  of 
bile,  but  merely  a suspended  function  of  the  liver.  How  the 


Spencer  on  Asiatic  Cholera. 


33 


cutting  oft’ of  the  materials  for  the  manufacture  of  bile  takes 
place,  in  the  progress  of  this  disease,  will  be  afterwards  con- 
sidered. Thus  far  we  have  found  the  evidence  of  little  else, 
except  disorder  of  all  the  viscera  concerned  in  digestion,  and 
the  question  recurs  whether  any  of  these  give  evidence  of  the 
epidemic  predisposition. 

In  health  the  avenue  to  the  lacteals  is  guarded  by  the  ex- 
halents  which  pour  out  their  fluids  rapidly,  washing  out  any 
irritating  substance  sent  to  them  by  the  stomach. 

This  is  exemplified  in  the  operation  of  cathartics,  which  by 
the  irritation  they  produce,  excite  a discharge  from  the  villi 
of  the  intestines,  that  are  the  seat  of  serous  exhalation.* 
Large  indigestible  meals,  or  substances  unacted  upon  by  the 
stomach,  have  a like  effect,  and  are  often  washed  out  by  these 
discharges.  Under  ordinary  circumstances,  however,  our 
food,  even  if  imperfectly  digested,  is  taken  up  by  the  lacteals. 
This  is  exemplified  in  dyspepsia,  jaundice,  and  various  other 
conditions  of  the  system,  in  which  no  bowel  discharges  are  ex- 
cited, notwithstanding  digestion  is  feeble,  and  no  bile  mixes 
with  the  chyme  prepared  by  the  stomach.  During  the  epi- 
demic, immense  numbers  were  affected  with  diarrhoea,  with- 
out any  evident  exciting  cause,  except  their  accustomed 
meals,  and  as  chyme  and  water  were  generally  the  earliest 
fluids  discharged,  it  is  thought  rational  to  infer,  that  the  im- 
perfectly digested  food  excites  the  intestinal  exhalents,  and 
is  washed  out.  This  is,  of  course,  a slight  irritant,  and  we 
have  found  the  chyle  ordinarily,  under  like  circumstances, 
taken  into  the  circulation.  If  this  slight  excitant  produces 
such  universal  diarrhoea,  whence  does  it  arise  ? The  cause  re- 
maining equally  intense,  the  part  to  be  acted  upon  must  be 
more  susceptible  to  the  action  of  stimuli,  or  this  universal  ef- 
fect would  notbe  produced.  In  speaking  of  the  laws  of  epidem- 
ics, it  was  found  that  some  organ  or  tissue  becomes  generally 
predisposed,  and  ready  to  respond  to  the  action  of  slight  stim- 
ulants or  exciting  causes.  In  this  epidemic,  we  find  the  ex- 
halents thus  morbidly  susceptible,  even  the  slight  change  of 

1 See  Jackson’s  Principles  of  Medicine,  p.  55, 


34 


Spencer  on  Asiatic  Cholera. 


the  irritating  qualities  of  the  food  from  indigestion,  producing 
diarrhoea.  The  exhalent  tissue  of  the  nntestinal  membrane 
must  therefore  be  the  seat  of  predisposition  induced  by  the 
epidemic  influence.  Have  we  any  other  evidence  of  this  part 
being  the  seat  of  morbid  susceptibility  ? During  the  prevalence 
of  the  epidemic,  an  apple,  an  orange,  emotions  of  the  mind, 
slight  exposures  to  cold,  which  are  ordinarilv  borne  with  im- 
punity, would  often  produce  diarrhoea.  The  smallest  doses  of 
cathartic  drugs,  or  even  the  mild  laxatives,  as  a Seidlitz  pow- 
der, or  a dose  of  castor  oil,  would  frequently  produce  profuse 
discharges  from  the  bowels.  The  proof  of  this  position 
does  not  rest  upon  my  individual  observation ; many  others 
have  noticed  the  same  circumstance  ; among  whom  I may 
mention  the  name  of  Dr.  Samuel  Jackson,  who  remarks,*  “ that 
before  and  at  the  period  of  the  invasion  of  the  disease,  affec- 
tions of  the  stomach  and  bowels  were  universally  prevalent. 
A state  of  irritability  existed  in  the  alimentary  canal,  which 
rendered  it  liable  to  be  disordered  from  slight  causes,  that  at 
other  times  would  scarcely  have  been  felt.  This  condition 
continued  to  increase,  and  during  the  last  weeks  of  July  and 
beginning  of  August,  there  were  few  persons  in  the  city  (Phil- 
adelphia) who  were  not  complaining  of  being  unwell  from 
feelings  of  this  kind.  It  is  hardly  exaggeration  to  assert,  that 
in  this  period  from  fifty  to  sixty  thousand  people  experienced 
this  species  of  light  disorder.”  Dr.  Walker,  who  was  sent 
from  St.  Petersburgh  to  Moscow,  by  the  British  ambassador, 
says  in  his  report,  “ that  a peculiar  state  of  the  atmosphere  was 
proved  by  almost  every  person  in  the  city  (Moscow)  feeling 
during  the  time  some  inconvenience  or  other,  which  wanted 
only  the  exciting  cause  of  catching  cold,  or  some  irregularity 
of  diet,  to  bring  on  cholera.”  Dr.  Payne  remarks  : “ Theory 
and  experience  all  give  way  to  the  overwhelming  argument 
of  a choleric  atmosphere.  The  constipated  dyspeptic  aban- 
dons his  bolus  of  soap  and  aloes,  and  condemns  unbolted  flour 
as  a purgative,  and  even  the  shampooing  of  Halstead  threat- 

* In  a paper  prepared  lor  the  American  Journal  of  Medical  Sciences,  icr  Feb. 
1333,  and  which  he  obligingly  allowed  me  to  lead  in  proof. 


Spencer  on  Asiatic  Cholera . 


35 


ens  him  with  hyper-catharsis.”  In  answer  to  a circular  in- 
viting information  relative  to  the  epidemic,  Dr.  Azariah  B. 
Shipman  of  Manlius,  N.  Y.  says  : “ I remarked  early  in  the 
spring  that  a majority  of  cases  of  disease  were  attended  with 
an  unusual  degree  of  gastro-intestinal  irritation,  and  that  small 
doses  of  purgative  medicines,  often  produced  hyper  catharsis, 
and  that  diarrhoea  was  an  annoying  attendant  on  cases  of  dis- 
ease, with  which  I had  not  been  accustonjed  to  see  it  compli- 
cated.” In  answer  to  a like  enquiry,  Dr.  Thomas  Miner  of 
Middletown,  Conn,  remarks : “ There  is  one  important  cir- 
cumstance which  I ought  by  no  means  to  omit.  From  about 
the  middle  of  August  to  about  the  middle  of  October,  there 
was  very  generally  prevailing  a peculiar  epidemic  constitu- 
tion or  predisposition  to  disease,  which  was  manifest  by  the 
state  of  the  stomach.  The  fruits  of  the  season,  though  gener- 
ally good,  and  in  their  usual  perfection  and  abundance,  could 
be  rarely  eaten  with  any  thing  like  their  usual  freedom,  with- 
out producing  a very  unpleasant  sensation  in  the  stomach 
and  bowels,  and  a tendency  to  diarrhcea.  This  was  not  im- 
aginary, but  so  palpable  that  very  few  persons  could  indulge 
in  fruit  at  all.”  It  would  thus  appear,  that  even  in  those  sec- 
tions of  the  United  States,  which  the  severe  grades  of  the  epi- 
demic scarcely  visited,  the  same  general  predisposition  was 
given  to  diarrhoeal  diseases.  Dr.  John  M’Call  of  Utica,  at 
an  early  period  mentioned  to  me  the  belief,  that  many  cases 
of  the  severe  disease  in  that  city,  were  excited  by  cathartic 
drugs ; and  I am  indebted  to  Dr.  Peckham  of  the  same  place 
for  the  remark,  that  “ artificial  is  equally  hazardous  with 
natural  diarrhoea.”  Cathartics  always  act  by  exciting  the 
intestinal  exhalents.  In  health  they  produce  little  mischief. 
If,  then,  they  are  found  during  the  prevalence  of  the  epidemic 
to  produce  such  violent  effects,  we  might  almost  from  this  cir- 
cumstance alone  sufficiently  prove  the  existence  of  the  uni- 
versal predisposition  in  the  community,  given  by  the  general 
cause  of  this  malady,  to  be  in  the  intestinal  exhalents. 

The  other  phenomena  of  this  stage  require  but  a passing 


36 


Spencer  on  Asiatic  Cholera. 


notice.’  The  involuntary  discharges  which  occasionally 
happen  while  the  patient  is  about,  may  be  accounted  for  front 
the  circumstance  that  scarcely  any  thing  but  water  is  dis- 
charged, and  which  excites  no  irritation.  The  sharpened  fea- 
tures indicate  that,  the  usual  source  of  nourishment  being  cut 
off,  the  absorbents  begin  to  take  up  the  cellular  and  waste 
parts  of  the  body,  and  carry  them  to  the  circulation  for  its- 
nourishment.  Scanty  urine  and  dry  skin  can  be  accounted  for 
by  the  sympathetic  relations  existing  between  the  intestines, 
skin  and  kidneys,  by  which  discharges  from  the  one  are  often 
substituted  for  the  other,  and  which  will  be  farther  noticed 
when  we  come  to  treat  of  the  pathology  of  the  second  stage. 

3.  Of  intemperance  and  filth  as  predisposing  causes. — 
Connected  with  this  subject  may  now  be  noticed  the  opera- 
tion of  intemperance  and  filth,  the  history  of  this  disease  hav- 
ing proved  their  frequent  agency  in  producing  a disposition 
to  attacks.  Intemperance  always  weakens  the  digestive 
functions,  as  evinced  by  anorexia,  heartburn,  pain  in  the 
stomach,  and  frequent  diarrhoea,  to  which  this  class  of  the 
community  are  subject.  The  liver  sooner  or  later  partakes 
of  this  derangement,  as  evinced  by  want  of  bile  in  the  evacu- 
ations, and  chronic  enlargement  of  this  organ.  Associated 
with  drunkenness,  we  always  have  its  twin  brother,  filth, 
which  acts  upon  the  same  organs,  as  shown  by  its  effects  upon 
the  temperate,  when  exposed  to  its  exhalations,  by  destroying 
the  appetite,  and  often  exciting  nausea  and  diarrhoea.  Here 
then  we  have  two  causes  associated,  acting  upon  the  same 
individuals,  and  producing  the  like  disposition  to  diarrhoea 
as  the  epidemic  influence,  and  a concentration  of  causes  makes 
them  the  ready  victims.  The  intemperate  are  so  subject 
to  diarrhoea,  that  it  scarcely  invites  their  notice,  till  the  at- 
tack brings  them  to  the  very  verge  of  death.  We  can  read- 
ily discover  how  the  impure  atmosphere  of  the  town  should 
predispose  to  this  epidemic,  independent  of  the  operation  of 

■'  Dizziness,  deafness  and  affections  of  sight,  which  occasionally  occur  in  the  lat- 
ter part  of  this  stage  and  in  the  second,  so  generally  occur  in  all  great  disturban- 
ces of  the  economy,  as  to  demand  no  special  notice. 


Spencer  on  Asiatic  Cholera. 


37 


the  moral  exciting  causes  hereafter  to  be  noticed,  of  the  com- 
munication of  fear  and  terror,  so  readily  disseminated  in  a 
dense  population.  We  may  now  sum  up  in  a few  proposi- 
tions the  pathology  of  this  stage. 

Recapitulation. — 1.  The  epidemic  influence  being  thrown 
upon  the  exhalent  tissue  of  the  small  intestines,  renders  it 
highly  susceptible  to  the  action  of  irritants,  so  that  the  imper- 
fectly digested  food  or  mild  laxatives  often  excite  profuse 
evacuations,  and  there  is  thus  produced  a disposition  to  vio- 
lent disease  from  the  common  exciting  causes  of  diarrhoea. 

2.  The  stomach  being  weakened  in  its  function,  digestion 
is  imperfectly  performed,  and  at  times  almost  suspended. 

3.  The  liver  responding  to  the  stomach  from  its  habitual 
sympathetic  relations  with  that  organ  in  health,  falls  into  a 
state  of  torpor,  and  bile  is  no  longer  secreted. 


CHAPTER  IV. 

OF  THE  PATHOLOGY  OF  THE  SECOND  STAGE. 

1.  Of  the  origin  of  the  intestinal  discharges. — In  com- 
mencing our  researches  into  the  nature  of  the  second  stage, 
the  most  prominent  symptom  presented  is  the  immense  in- 
crease of  the  intestinal  discharges.  Diarrhoea,  which  consti- 
tutes so  prominent  a part  of  every  stage,  hut  especially  this, 
demands  a critical  examination  in  its  relations  as  an  immediate 
effect  of  the  cause,  and  in  its  relations  as  a cause  in  producing 
many  of  the  resulting  phenomena  of  this  epidemic.  What  is 
the  origin  of  these  immense  discharges  ? And  how  do  they  find 
their  way  into  the  inner  surface  of  the  intestines  ? Some  nat- 
ural or  artificial  outlet  must  give  exit  to  these  fluids.  Satis- 
factorily to  answer  these  enquiries,  however,  is  it  necessary 
to  recur  to  the  anatomical  structure,  and  the  physiological 
offices  of  the  intestinal  membranes  in  health  ? In  the  or°:an- 
ization  of  these  membranes,  notwithstanding  they  are  denom- 

6 


Spencer  on  Asiatic  Cholerd. 


36 

inated  mucous , they  are  sero  mucous*  combining  the  proper- 
ties both  of  the  serous  and  mucous  tissues.  In  these  mem- 
branes, then,  are  found  all  the  elements  that  enter  into  the 
composition  of  the  serous  membranes,  with  the  addition  of  the 
mucous  tissue,  which  is  beset  with  innumerable  glandular 
bodies,  named  from  their  discoverers,  f In  the  healthy  con- 
dition of  the  membranes,  these  glands  discharge  a lubricating 
fluid,  which  protects  their  inner  surface  from  the  irritative 
action  of  the  nutritive  substances,  sent  to  them  from  the  stom- 
ach. Like  all  glandular  bodies,  these  follicles  perform  a slow 
elaboration  from  the  blood,  which  is  interrupted  in  its  pro- 
gress by  the  complicated  structure  that  always  enters  into  the 
organization  of  the  glandular  tissues.  These  membranes, 
then,  in  addition  to  the  glandular  structure  referred  to, 
must  have  entering  into  their  composition  all  the  elements 
which  make  up  what  are  called  the  serous  membranes,  to 
wit,  capillary  arteries,  veins,  absorbents,  exhalents,  nerves, 
and  condensed  cellular  tissue.  There  open  upon  the  inner 
surface  of  these  membranes,  the  excretory  ducts  of  the  glan- 
dular bodies  alluded  to,  and  those  of  other  glands,  as  the  liver 
and  pancreas.  Now,  from  some  of  these  sources  we  are  to 
look  for  the  intestinal  discharges  in  the  present  epidemic.  If 
they  come  from  the  capillary  arteries  or  veins,  a rupture  must 
give  exit  to  them,  and  we  should  then  expect  that  these  fluids 
would  be  tinged  with  blood,  a circumstance  which  at  times 
happens  when  the  evacuations  look  like  the  washings  of  beef. 
Opposed  to  this  supposition  of  ruptured  arteries  or  veins,  is 
the  fact,  that  the  discharges  are  generally  clear  or  rice-colour- 
ed, and  it  would  be  absurd  to  believe  that  an  infinite  number 
of  small  ruptures  should  be  made  for  the  exit  of  the  watery 
to  the  exclusion  of  the  red  particles  of  blood.  We  are  there- 
fore to  look  to  some  of  the  natural  openings  of  vessels  upon 
this  surface  for  the  source.  Few  would  be  found  to  advocate 
the  belief,  that  the  liver  or  pancreas  could  he  so  changed  from 
its  healthy  function  as  to  give  exit  to  these  fluids  through  its 


Bichat  on  the  membranes. 


Pecer  and  Brunner, 


Spencer  on  Asiatic  Cholera. 


39 


excretory  duct.  In  addition  to  these,  there  open  the  ducts 
from  the  minute  glands  of  the  mucous  tissue,  and  from  which 
these  fluids  might  flow,  without  the  supposition  of  disorgani- 
zation of  any  part — a circumstance  proved  not  to  happen 
when  they  die  in  collapse,  by  the  whole  record  of  dissections. 
Although  no  lesion  of  structure  takes  place,  these  little  glan- 
dular bodies  are  often  found  exceedingly  prominent  on  dis- 
sections of  those  dying  of  this  epidemic,  and  this  has  led 
many  to  believe,  that  these  were  the  source  of  the  immense 
discharges.  The  healthy  functions  of  these  glands  being  to 
secrete  mucus,  it  would  be  necessary  to  suppose  an  entire 
change  of  action,  to  make  them  the  source  of  the  serous  dis- 
charges. The  parotid  glands,  the  liver  and  the  pancreas 
often  have  their  natural  secretions  greatly  increased,  but  the 
discharges  from  these  glands  always  retain  their  distinctive 
characters.  It  is  thought  this  may  be  said  of  all  glands.  As 
these  little  intestinal  glands  are  subject  to  the  general  laws  of 
this  structure,  it  can  hardly  be  believed  that  so  entire  a change 
can  take  place  in  their  actions,  (which  are  slowly  and  elab- 
orately performed  in  health)  as  to  give  such  rapid  exit  to 
serous  fluids  as  must  be  required  to  have  them  the  proximate 
seat  of  disease.  The  flocculce  and  mucus  often  mixed  with 
the  discharges,  giving  them  colour,  probably  come  from  the 
glandular  structure  of  the  intestines.  If  the  idea  of  the  large 
discharges  coming  from  this  source  be  rejected,  it  may  be  en- 
quired how  the  prominences  of  these  glands  can  be  account- 
ed for  in  those  who  die  of  this  disease.  No  pathological  prin- 
ciple seems  better  established  than  that  a rush  of  fluids  is  al- 
ways determined  to  an  irritated  part.  If  there  is  a current  of 
fluids  (hereafter  to  be  noticed)  to  the  intestines,  these  glands 
could  hardly  escape  receiving  an  increased  proportion,  and 
they  would  become  distended  from  the  tortuous  and  compli- 
cated vascular  structure  entering  into  their  composition.  This 
explanation  of  the  pathological  condition  of  these  glands  re- 
ceives further  confirmation  from  the  circumstance  that  they 
are  found  much  more  prominent  when  the  patient  dies  in  col- 


40 


Spbncek  on  Asiatic  Cholera. 


lapse,  than  when  he  has  suffered  from  reaction  or  fever.* 
In  the  latter  case  these  glands  have  time  to  recover  from  their 
previous  distention.  Another  source  of  these  fluids  might  be 
from  the  absorbents  which  open  by  innumerable  mouths  upon 
the  inner  surface  of  the  intestinal  membranes,  and  here  called 
lacteals.  Many  respectable  physicians  have  believed  this  the 
origin  of  these  fluids,  and  this  doctrine  likewise  requires  exam- 
ination. In  order  to  this,  there  must  be  a retrogade  motion 
of  the  absorbents.  The  structural  organization  of  these  ves- 
sels offers  an  insuperable  objection  to  this  hypothesis  in  the 
present  disease.  There  are  throughout  the  whole  extent 
of  the  absorbents  to  be  found  valves,  which  constantly  in- 
terpose a barrier  to  the  regurgitation  of  fluids.  In  addition 
to  these,  the  chyle  passes  through  the  mesenteric  glands,  in 
which  structure  there  is  always  interposed  an  obstruction  to 
the  rapid  transit  of  fluids.  But  if  both  these  impediments 
were  overcome,  what  volume  of  fluids  would  the  lacteals  con- 
tain ? A quart  or  two  at  most.  Allowing  them,  however, 
the  capacity  of  a gallon,  would  this  account  for  these  immense 
discharges  ? They  are  frequently  a gallon  every  few  min- 
utes, until  several  are  discharged — respectable  physicians  es- 
timating the  amount  often  lost  in  this  epidemic,  at  from  twen- 
ty to  fifty  pounds.  When  the  lacteals  become  emptied,  they 
must  draw  their  fluids  directly  from  the  veins  into  which  they 
empty.  If  this  occurred,  it  would  be  absurd  to  suppose,  that 
the  mouths  of  these  vessels  would  select  the  watery  parts  of 
the  blood  to  the  exclusion  of  the  red  globules.  We  have 
now  examined  every  source  but  one,  without  finding  any  from 
which  these  large  serous  discharges  can  be  derived.  The 
only  one  remaining  is  the  exhalent  tissue  of  the  intestines,  and 
it  is  believed  we  may  now  draw  the  inference  that  the  exha- 
lents  are  the  floodgates  by  which  the  vital  fluids  are  thus  rap- 
idly drained  from  the  body.  If,  then,  these  vessels  give  exit 
to  the  discharges,  may  we  not  infer  that  the  exhalent  tissue 

* Dr.  Hays. 


Spencer  on  Asiatic  Cholera.  • §§^  41 

of  the  howels  is  the  proximate  seat  of  disease  in  the  second 
stage , as  well  as  in  the  first,  as  already  proved.  In  the  ex- 
halents,  then,  we  have  a natural  outlet  to  these  fluids,  and  of 
course  should  expect  no  lesion  of  the  membranes  when  the 
patient  died  in  collapse — a fact  most  fully  proved  by  the  uni- 
versal testimony  of  the  profession,  who  have  made  a record 
of  their  dissections,  throughout  the  globe.  It  is  believed  that 
the  essential  phenomena  yet  to  he  accounted  for,  can  he  traced 
to  these  discharges  as  a cause , and  if  so,  the  conclusion  seems 
irresistible  that  we  have  correctly  arrived  at  the  proximate 
seat  of  disease.  If,  then,  the  proximate  seat  of  disease  is  the 
same  as  in  the  first  stage,  when  all  will  admit  the  disease  is 
serous  diarrhoea,  shall  we  change  the  name  and  call  it  “ chol- 
era,” because  an  indigestible  meal  or  a debauch  greatly  in- 
creases these  serous  discharges,  and  vomiting  supervenes  ? 
In  what  has  preceded,  we  have  noticed  only  the  serous  evac- 
uations, while  the  colour  has  not  been  accounted  for.  The 
first  effects  which  would  naturally  result  from  these  dis- 
charges would  be  to  wash  out  whatever  might  be  in  the  ali- 
mentary canal  at  their  commencement.  At  times  these  are 
yellow,  or  they  look  like  dirty  water , throughout  the  disease, 
and  the  discharges  in  these  cases  have  a feculent  smell.  Dis- 
sections have  shown  about  five  cases  in  one  hundred  in  which 
the  colon  was  distended  with  feculent  matter  in  those  who 
have  died  of  this  disease,  and  this  circumstance  rationally  ac- 
counts for  such  occasional  appearance  of  the  discharges.  If 
part  of  the  food  remains  upon  the  stomach,  or  the  chyle  re- 
mains unabsorbed,  this  gives  colour  to  the  evacuations,  which 
sometimes  resemble  milk  and  water,  or  thin  gruel.  The  fol- 
licular glands  at  times,  on  dissection  have  been  found  to  exude 
a milky  fluid,  which  may  likewise  give  this  or  the  rice-co- 
lour to  the  serous  discharges.  Rice-coloured  evacuations  are 
often  observable  in  the  chronic  intestinal  diseases  of  children. 
The  red  tinge  seen  at  times  in  the  latter  stages  of  this  disease, 
and  in  the  intestinal  contents  on  dissection,  must  result  from 
the  admixture  of  red  globules  of  blood  with  the  serum  of  the 
discharges.  Colour  would,  therefore,  appear  as  an  accidental 


42 


Spencer  on  Asiatic  Cholera » 


circumstance,  while  the  serum  of  the  discharges  is  uniform, 
and  in  a large  proportion  of  cases  almost  colourless.*  When 
the  pathological  relations  to  other  diarrhceal  affections  are  trac- 
ed, serous  discharges  will  be  found  to  constitute  the  source 
of  danger  in  all. 

2.  Of  the  immediate  cause  of  these  discharges. — If  then 
the  source  of  these  fluids  is  what  has  been  represented,  yet  it 
may  be  said  that  this  does  not  explain  the  particular  condi- 
tion of  the  membranes,  giving  exit  to  them.  Much  contra- 
riety exists  among  medical  men  in  their  views  of  the  nature  of 
all  those  conditions  of  the  system  denominated  irritation,  in- 
flammation, congestion  and  sedation  ; and  until  some  definite 
ideas  are  affixed  to  each  term,  it  is  not  intended  to  enter  the 
controversial  list  to  attempt  to  point  out  the  particular  condi- 
tion, if  to  either  of  these,  this  malady  belongs.  It  is  sufficient, 
as  is  believed,  to  prove  the  position,  that  the  exhalents  give 
exit  to  these  immense  discharges.  May  not  the  actions  of 
these,  as  in  hemorrhage,  be  variable,  having  their  vitality 
morbidly  exalted  in  some  cases,  and  being  rather  passive  me- 
diums of  the  discharge  in  others  ? The  pathological  principle, 
that  whenever  a part  is  irritated,  a rush  of  fluids  is  directed 
towards  it,  has  been  handed  down  from  the  father  of  medicine, 
and  is  generally  admitted.  In  the  present  disease,  the  epi- 
demic influence  rendering  the  exhalent  tissues  susceptible, 
and  the  exciting  causes  all  having  a direct  tendency  to  irri- 
tate the  intestinal  membranes,  we  should  expect  a rush  of 
fluids  towards  them.  That  this  takes  place  is  inferible  from 
the  rapidity  of  these  discharges,  which  could  hardly  be  sup- 
posed possible,  unless  a larger  proportion  of  fluids  was  sent 
to  these  parts,  than  in  health.  This  appears  likewise  deduci- 
ble  from  the  circumstance,  that  morbid  changes  have  been 
much  most  frequently  observed  in  the  abdominal  viscera, 
being  often  engorged  with  blood.  This  epidemic  bears  a more 
striking  analogy  to  intestinal  hemorrhage  than  any  malady 
except  the  other  varieties  of  diarrhceal  diseases.  Hemorrhage 


Scott. 


Spencer  on  Asiatic  Cholera . 


43 


has  been  most  satisfactorily  proved  to  take  place  from  the  ex- 
halents,  when  it  is  a primary  disease,*'  and  no  modern  wri- 
ter but  Gregory,  it  is  thought,  controverts  this  position.  Dis- 
sections after  the  epidemic  and  after  hemorrhage,  show  a 
striking  resemblance,  the  structure  of  the  membrane  in  both 
remaining  entire.  Indeed,  the  principal  difference  between 
these  two  appears  to  be,  that  in  the  epidemic  a kind  of  secre- 
tory action  only  admits  the  watery  and  saline  parts  of  the 
blood  to  pass,  while  in  hemorrhage  all  its  parts  are  discharged. 
Indeed,  in  the  latter  stage  of  the  epidemic,  the  evacuations 
are  often  tinged  with  the  red  globules.  The  striking  analogy 
in  the  effects  resulting  from  hemorrhage  will  be  pointed  out, 
when  we  come  to  speak  of  the  effects  of  these  serous  discharg- 
es upon  the  circulating  system. 

3.  Of  the  effects  of  the  discharges  upon  the  mass  of 
circulating  fluids. — Marked  changes  are  observable  in  the 
chemical  composition  of  the  blood  in  this  epidemic,  and  it  pre- 
sents a question  of  interesting  import  to  determine,  whether 
the  phenomena  of  this  disease  result  from  such  change  in  its 
pathological  condition,  or  whether  the  alteration  of  the  fluids 
results  as  a mere  effect  of  the  discharges.  Chemical  analyses 
in  the  first  stage  of  the  disease  show  no  essential  change 
in  the  composition  of  the  fluids,  while  on  the  contrary  in  the 
collapse,  there  is  an  entire  alteration  in  the  relative  propor- 
tions of  its  ordinary  ingredients.  That  this  change  of  the 
fluids  produces  some  of  the  phenomena  of  this  disease,  and 
that  the  alterations  which  take  place  in  the  circulating  mass, 
in  the  progress  of  this  and  other  maladies,  has  been  too  much 
overlooked  by  many  modern  pathologists,  is  unquestionable, 
yet  it  is  believed  we  should  guard  against  the  other  extreme, 
of  explaining  every  thing  from  changes  in  the  blood,  as  too 
exclusive. 

It  is  obvious,  that  all  sources  of  supply  of  the  watery  and 
saline  parts  of  the  blood  are  cut  off,  since  the  stomach  and  in- 

3 By  Prof.  Chapman  in  his  Lectures  in  the  University  of  Pennsylvania,  and  in 
Bichat’s  General  Anatomy 


44 


Spencer  on  Asiatic  Cholera. 


testines,  which  in  health  perform  this  important  office,  are 
now  rapidly  withdrawing  these  ingredients,  and  every  thing 
taken  into  them  is  washed  out  by  the  exhalents.  The  source 
of  supply  being  thus  destroyed,  and  the  heart  and  blood  ves- 
sels being  a common  reservoir  from  which  all  the  discharges 
are  taken,  we  should  rationally  expect  that  the  mass  of  cir- 
culating fluids  would  be  deficient  in  those  elements  which 
enter  into  the  composition  of  the  fluids  evacuated — facts  fully 
proved  by  chemical  analysis,  as  stated  in  a preceding  chapter. 
From  this  it  may  be  reasonably  inferred,  that  the  changes  ob- 
servable in  the  chemical  composition  of  the  blood,  are  the  ef- 
fects of  the  discharges,  which  are  of  course  the  primary  cause 
of  the  phenomena  that  eventually  result  from  this  patholo- 
gical condition  of  the  fluids.  Is  it  not  reasonable,  then,  to 
conclude  that  the  changes  in  the  relative  proportions  of  the 
elements  of  the  blood,  would  bear  a ratio  to  the  extent  of 
the  discharges  ? Chemical  analyses  which  have  been  made 
support  the  affirmative  of  this  question  ; and  it  appears  the 
only  reasonable  mode  of  accounting  for  the  differences  in  the 
composition  of  the  blood  in  the  early  and  advanced  stages,  to 
believe  that  these  changes  result  at  this  period  from  the  pre- 
vious withdrawal  of  some  of  its  elements.  Depriving  this  fluid 
of  its  watery  parts,  would  tend  to  render  it  thicker  : thus  pre- 
senting a mechanical  obstruction  to  its  circulation,  and  pro- 
ducing other  phenomena,  to  be  noticed  in  another  place.  The 
free  oil,  discovered  in  the  blood  by  Dr.  Gale,*  does  not  ap- 
pear to  have  been  subjected  to  chemical  tests,  yet  no  doubt 
can  be  entertained  of  its  being  an  animal  oil.  It  probably 
comes  from  the  cellular  deposit  into  which  oil  enters  as  one 
of  its  proximate  principles,  brought  into  the  general  mass  by 
the  absorbents,  which  will  be  hereafter  proved  to  be  peculiar- 
ly active  in  this  disease.  But  why  remain  unchanged  in  the 
blood  ? The  answer  to  this  question  may  not  be  satisfactory, 
yet  the  following  appears  the  most  plausible  exposition  in  our 
present  state  of  knowledge.  Vital  changes  in  the  solids  or 

* Mentioned  in  Dr.  Payne’s  Letters  on  the  Epidemic. 


Spencer  on  Asiatic  Cholera . 


45 


fluids  are  entirely  inexplicable  upon  mere  chemical  laws,  yet 
these  appear  to  influence  some  of  the  alterations  in  the  ani- 
mal economy.  Chemical  analysis  of  the  blood  has  proved 
this  fluid  to  be  deprived  of  the  alkaline  ingredients  which 
usually  enter  into  its  composition.  These  out  of  the  body 
always  combine  with  and  change  the  sensible  properties  of 
oils ; and  unless  the  principles  of  life  which  are  in  the  collapse 
stage  much  enfeebled,  subjecting  the  system  to  be  influenced 
by  physical  laws,  entirely  change  chemical  affinities,  the  oil 
which  the  absorbents  bring  into  the  general  mass  might  be 
expected  to  remain  unchanged. 

4.  Of  the  effects  of  the  discharges  on  the  heart  and  cir- 
culation.— As  yet  we  have  only  traced  these  serous  discharg- 
es to  the  exhalent  vessels  as  their  source,  but  the  effects  upon 
the  organs  which  are  the  fountain  of  these  fluids,  remain  to  be 
examined.  Coming  directly  from  the  general  mass  of  the  cir- 
culating fluids,  the  most  direct  effect  produced  must  be  to 
lessen  their  volume,  and  thereby  take  off  from  the  heart  and 
blood  vessels  the  stimulus  of  distention.  What  should  be  ex- 
pected from  this,  but  failure  of  the  actions  of  the  heart  and 
arteries  proportioned  to  the  extent  and  rapidity  of  the  evacua- 
tions? If  this  be  the  immediate  consequence  of  unloading  the 
blood  vessels,  can  we  wonder  at  the  sudden  sinking  when 
the  amount  of  fluids  is  often  equal,  nay  more,  in  a few  hours, 
than  the  estimated  quantity  of  the  whole  volume  of  circulat- 
ing mass  in  the  heart  and  blood  vessels  ? What  are  the  ef- 
fects, for  instance,  of  blood  letting  ? The  pulse  is  found  to 
grow  feeble  in  proportion  to  the  extent  and  rapidity  of  the  dis- 
charge, and  if  carried  too  far  the  heart  fails  to  beat,  or  pul- 
sates feebly,  respiration  is  slowly  or  convulsively  performed, 
and  if  carried  still  farther,  we  have  faintings,  at  times  convul- 
sions or  spasms,  coldness  of  the  whole  surface,  &c.  How 
different  are  these  phenomena  from  the  prominent  symptoms 
of  the  epidemic  ? The  general  explanation  of  the  effects  of 
bleeding  is,  that  the  symptoms  result  from  the  sudden  man- 
ner in  which  the  blood  vessels  are  unloaded.  But  I may 
here  be  met  bv  the  objection,  that  the  discharges  being  differ- 

7 


46  Spencer  on  Asiatic  Cholera , 

ent,  like  effects  could  not  be  expected.  The  saline  parts  of 
the  blood  are  necessary  to  its  due  arterialization,  as  most  am- 
ply proved  by  Dr.  Stevens,  and  others ; and  water,  which 
constitutes  ninety-nine  hundreths  of  these  discharges,  is  an 
important  ingredient  for  preserving  the  life  of  all  organized 
matter,  whether  vegetable  or  animal.  All  great  discharges 
produce  the  same  general  train  of  symptoms.  Profuse  sweat- 
ing always  rapidly  diminishes  the  force  of  the  heart  and  ar- 
teries. The  same  may  be  said  of  profuse  discharges  of  urine. 
Witness  the  extensive  ravages  produced  by  this  cause  in  the 
diabetic  patient.  The  effects  of  colliquative  diarrhoeas  in 
hectic,  and  indeed  in  all  febrile  diseases,  are  rapidly  to  im- 
pair the  vigor  of  the  circulation.  The  objection  may  here 
be  raised,  that  the  intestinal  evacuations  are  at  times  altogeth- 
er too  small  to  account  for  the  severe  train  of  symptoms  and 
death,  which  happen  in  this  epidemic.  Constitutional  pe- 
culiarities always  vary  the  effects  of  all  evacuations.  Dr. 
Marshall  Hall,  in  his  researches  on  the  effects  of  the  loss  of 
blood,  says  : “ it  will  be  readily  conceived  that  hypercathar- 
sis and  diarrhoea  may  induce  the  symptoms  of  exhaustion  in 
adults  as  well  as  children.  In  some  cases  of  great  suscep- 
tibility to  exhaustion,  this  event  is  very  remarkable,  and  oc- 
curs when  from  the  degree  and  measure  of  its  cause,  it  could 
scarcely  have  been  suspected.”  The  force  of  this  remark  of 
Dr.  Hall  must  strike  every  one,  and  a like  observation  holds 
as  to  bleeding,  which  cannot  be  borne  by  some  individuals  to 
any  considerable  extent,  without  the  most  alarming  conse- 
quences. In  numerous  cases  likewise  of  sudden  death,  with- 
out intestinal  discharges,  dissections  have  shown  the  bowels 
filled  with  serous  fluids,  in  this  respect  similating  concealed 
hemorrhages.  During  the  prevalence  of  all  great  epidemics, 
cases  of  sudden  death  occur  without  the  developement  of  the 
usual  symptoms  of  the  prevalent  disease.  Shall  we  on  that 
account  be  denied  the  privilege  of  accounting  for  the  general- 
ity of  cases  according  to  the  established  laws  of  living  or- 
ganism ? 

How  does  this  epidemic  differ  from  hypercaiharsis  produc- 


Spencer  on  Asiatic  Cholera. 


47 


ed  by  elaterium  or  croton  oil  ? These,  if  taken  in  large  doses, 
always  induce  profuse  serous  discharges.  Medical  men  have 
for  ages  agreed,  that  they  produce  them  by  the  irritation  they 
induce  upon  the  exhalent  tissue  of  the  intestines,  from  whence 
the  fluids  are  discharged.  It  has  been  proved  that  the  evacu- 
ations come  from  the  same  source  in  the  epidemic.  If  so,  a 
similar  effect  should  be  expected.  This  is  strikingly  the  case, 
as  must  be  obvious  to  every  observing  physician,  and  to  enu- 
merate the  effects  would  only  be  to  enumerate  the  prominent 
symptoms  of  the  epidemic.  There  is  an  exception,  however, 
to  hydragogue  cathartics  producing  these  severe  effects.  In 
dropsical  cases,  for  instance,  gallons  are  discharged,  by  the 
operation  of  a brisk  cathartic,  and  yet  the  patient  is  scarcely 
reduced  in  strength,  and  at  times  appears  invigorated.  What 
produces  the  marked  difference  of  effects  observable  in  these 
instances  ? In  dropsy,  the  effused  fluids  are  thrown  out  of  the 
general  mass  of  circulating  fluids  into  cavities.  During  the 
operation  of  the  cathartic,  the  absorbents,  by  innumerable 
mouths,  take  up  the  effused  fluids,  a rapid  transfer  occurs 
through  the  medium  of  the  blood  vessels,  and  they  are  dis- 
charged from  the  intestinal  exhalents.  In  this  case,  the  heart 
and  arteries  are  supplied  from  the  dropsical  fluids,  as  rapidly 
as  serous  discharges  take  place  from  the  bowels.  On  the 
contrary,  when  there  are  no  such  sources  of  supply  to  the 
heart,  its  function  rapidly  fails  from  loss  of  the  stimulus  of 
distention.  When  speaking  of  the  pathological  analogy  of 
the  epidemic  to  hemorrhage,  a comparison  of  effects  was 
promised.  In  hemorrhage,  when  the  evacuations  of  blood 
are  rapid,  a much  less  quantity  is  necessary  to  induce  death, 
than  when  slowly  withdrawn  ; in  which  case  almost  the 
whole  volume  of  the  circulating  mass  is  sometimes  discharg- 
ed before  death  ensues.  This  was  strikingly  the  case  in 
the  epidemic,  and  both  seem  to  admit  the  same  exposition 
from  the  difference  of  times  allowed  for  the  blood  vessels  to 
contract  upon  their  contents.  In  hemorrhage,  we  have  sink- 
ing of  the  pulse,  slow  or  convulsive  breathing,  syncope,  occa- 
sionally convulsions,  cold  clammy  sweats,  corrugations  of  the 


48 


Spencer  on  Asiatic  Cholera. 


hands,  retention  of  muscular  power,  enabling  the  patient  to 
turn  in  bed,  thirst,  dulness,  but  entire  retention  of  the  mental 
powers,  marble  coldness  of  the  extremities,  shrinking  of  the 
features.  Spasms  and  vomiting  are  both,  though  not  as  fre- 
quently, present.  Could  a better  description  of  symptoms, 
resulting  from  the  epidemic  be  given,  than  those  occurring  in 
hemorrhage?  If  such  a marked  similarity  is  observable  in  the 
phenomena  of  these  two  diseases,  is  it  not  reasonable  to  infer, 
that  they  result  from  the  same  cause — the  unloading  of  the 
blood  vessels  ? 

5.  Of  the  effect  upon  the  respiratory  and  capillary  func- 
tions.— The  function  of  the  lungs  unceasingly  depends  upon 
the  volume  and  quantity  of  the  circulating  fluids  sent  to  them 
by  the  heart.  This  dependence  is  indeed  reciprocal,  and 
whatever  interrupts  the  healthy  performance  of  respiration 
suddenly,  arrests  the  function  of  the  heart,  as  evinced  by  the 
effects  of  noxious  vapors.  The  first  enquiry  that  here  pre- 
sents itself  is,  how  the  lessening  of  the  volume  of  circulating 
fluids,  and  consequent  failure  of  the  heart’s  function,  inter- 
rupts the  due  arterialization  of  the  blood  ? Every  organ  de- 
pends for  its  function  upon  the  due  supply  of  its  accustomed 
stimulus,  and  the  blood  being  the  natural  stimulus  of  the 
lungs,  if  the  general  mass  was  lessened,  and  the  heart  ceas- 
ed to  perform  its  function  vigorously,  we  should  expect  to 
find  what  Mr.  Scott  remarks  often  happens,  “ that  in  many 
cases  terminating  in  death,  respiration  has  gone  on  in  its  me- 
chanical part,  with  little  or  no  interruption,  except  that  it 
becomes  slower  and  slower,  and  in  one  instance  was  perform- 
ed only  seven  times  in  a minute.”  This  I have  frequently  ob- 
served in  all  diseases,  and  the  frequency  of  respiration  bears 
a striking  proportion  to  the  rapidity  of  the  heart’s  movements, 
and  the  slow  breathing  in  this  disease  can  thus  be  readily 
traced  to  the  effects  of  the  discharges  upon  the  functions  of 
that  organ.  The  changes  which  are  gradually  taking  place 
in  the  relative  proportions  of  the  circulating  mass  appear  like- 
wise to  have  no  inconsiderable  share  in  producing  the  inter- 
ruption of  this  function,  water  being  an  essential  ingredient 


Spencer  on  Asiatic  Cholera , 


49 


to  prepare  it  for  ready  transmission  through  the  lungs  and  ca- 
pillary circulation.  Coldness  of  the  surface,  rapidly  increas- 
ing as  this  stage  advances,  is  what  should  be  naturally  ex- 
pected to  result  from  a failure  of  the  respiratory  functions, 
and  a want  of  the  due  quantity  of  blood  sent  by  the  heart  to 
the  capillaries,  as  animal  heat  always  depends  upon  the  due 
performance  of  the  functions  of  circulation  and  respiration. 

6.  Of  the  effects  upon  the  secretions  and  excretions. — 
Absence  of  bile  constitutes  a leading  symptom  in  this,  as  well 
as  the  first  stage.  The  lessening  of  the  general  mass  of  fluids 
and  the  failure  of  circulation,  would  have  a direct  tenden- 
cy to  lessen  the  materials  from  which  bile  could  be  elabora- 
ted, but  in  thise  pidemic  we  may  find,  in  the  organized  struc- 
ture of  the  intestines,  a direct  mode,  by  which  the  materi- 
als are  cut  off.  The  liver,  unlike  the  other  glands  of  the 
body,  prepares  the  bile  from  the  venous  blood.  From  whence 
is  this  derived  ? Through  the  medium  of  the  vena  portae,  from 
the  extreme  branches  of  the  mesenteric  arteries,  distributed 
to  the  intestines,  and  other  abdominal  viscera.  The  current 
of  fluids  is  turned  to  the  inner  surface  of  the  intestines  in  this 
disease,  and  this  has  a direct  agency  in  interrupting  the  re- 
turn of  the  fluids  from  which  the  bile  is  secreted.  The  ab- 
dominal portal  vein  being  found  empty  on  dissections,  sup- 
ports the  above  exposition  of  this  symptom.  Suppression  of 
the  urinary  secretion  may  be  readily  accounted  for  by  a refer- 
ence to  some  of  the  established  laws  of  animal  life,  both  in 
health  and  disease,  by  which  discharges  from  one  part  fre- 
-quently  operate  as  a substitute  for  those  from  another.  Four 
important  functions  of  the  body  are  employed  in  excreting 
the  effete  or  waste  parts,  to  wit,  those  of  the  lungs,  the  bow- 
els, the  kidneys,  and  the  skin.  On  the  healthy  balance 
and  performance  of  these  functions,  health  unceasingly  de- 
pends. In  the  organised  structure  of  the  skin,  the  membranous 
air  passages  of  the  lungs,  and  membranes  of  the  bowels,  there 
is  an  entire  similarity,  with  the  exception  that  the  scarf  skin 
is  extremely  thin,  or  perhaps  in  some  places  wanting  in  the 
two  latter,  and  in  these  organs  we  have  three  exhalent  sur- 


50 


Spencer  on  Asiatic  Cholera. 


faces,  perhaps  nearly  equal.  In  the  kidneys,  we  have  a 
structure  different,  but  from  these  are  likewise  secreted  aqu- 
eous and  saline  fluids.  One  of  these  discharges  is  often  sub- 
stituted for  the  other,  both  in  health  and  disease.  In  health , 
this  may  be  exemplified  by  the  effects  produced  from  sudden 
exposure  to  cold.  This  gives  a check  to  cutaneous  excre- 
tion, and  the  most  common  effect  observable  is  a simple  in- 
crease of  the  urinary  discharge,  and  no  serious  injury  is  done 
to  the  constitution.  At  another  time,  or  in  another  individ- 
ual, a slight  watery  diarrhoea  is  induced,  but  soon  subsiding, 
leaves  no  morbid  impression.  Under  other  circumstances,  a 
catarrhal  affection  is  produced,  which  is  generally  unattend- 
ed with  much  danger,  the  efforts  of  nature  being  able  in  a 
short  time  to  throw  off  the  disease.  If,  however,  the  dis- 
charge from  either  of  these  organs  is  diminished,  and  a cor- 
responding increase  does  not  happen  in  another,  febrile  or  in- 
flammatory disease  generally  results.  On  the  contrary,  when 
any  cause  increases  the  discharges  from  either  of  these  or- 
gans, a corresponding  diminution  takes  place  from  some  of 
the  others.  While  the  balance  of  these  functions  is  thus  pre- 
served, no  serious  injury  results ; but  when  these  discharges 
become  profuse,  disease  and  rapid  emaciation  are  the  conse- 
quences. In  disease  the  discharge  from  one  of  these  organs 
may  often  be  observed  to  operate  as  a substitute  for  the  other. 
In  intermittents,  for  instance,  the  solution  of  the  paroxysm  is  al- 
most always  brought  about  by  a free  perspiration.  Occasion- 
ally we  observe  that  a discharge  from  the  bowels,  kidneys  or 
lungs,  brings  about  the  like  solution.  The  same  may  be  ob- 
served in  other  fevers.  In  hectic,  the  diarrhoeal  discharges 
frequently  suspend  the  expectoration,  and  the  colliquative 
sweats  often  alternate  with  the  bowel  discharges.  “ In 
ischuria  renalis,  the  urine  taken  into  the  blood  vessels  is 
sometimes  determined  to  pass  off  by  the  intestines.”  (Cullen.) 

From  these  lawTs  of  the  four  functions  may  be  readily  de- 
duced the  reason  for  the  diminished  or  suspended  secretion 
of  urine,  which  finds  its  way  by  the  intestinal  outlet,  leaving 
nothing  from  which  the  kidneys  can  perform  their  usual 


Spencer  on  Asiatic  Cholera. 


51 


elaboration,  the  blood  having  lost  its  aqueous  and  saline  ele* 
ments.  Do  we  need  any  other  cause  than  the  large  discharg- 
es to  account  for  the  diminished  cutaneous  or  respiratory 
transpiration  ? A farther  evidence  that  the  bowels  in  this 
disease  become  the  outlet  of  the  venal  secretion,  may  be 
found  in  the  urinous  smell  and  saline  taste  of  the  discharges. 
Another  proof  is,  that  the  blood  at  the  commencement  of  the 
disease  is  found,  upon  chemical  analysis,  to  contain  the  neu- 
tral salts  usually  discharged  by  the  kidneys,  while  they  are 
deficient,  or  entirely  absent,  in  the  latter  stage  ; and  the  in- 
testinal evacuations  are  proved  to  contain  the  like  saline  in- 
gredients. The  appearances  on  dissection  show  a mere  sus- 
pended function  of  the  kidneys,  which  are  uniformly  found 
in  a healthy  condition,  and  the  bladder  contracted  into  a 
small  compass.  This  last  appearance  has  been  thought  by 
some  to  be  a peculiar  feature  of  this  epidemic,  but  involun- 
tary discharges  of  urine,  which  must  empty  the  bladder,  are 
among  the  common  precursors  of  death  ; and  Morgagni  men- 
tions that  this  viscus  is  almost  always  found  empty  upon  dis- 
section. Having,  as  is  thought,  sufficiently  proved,  that  the 
usual  excretions  from  the  other  organs  find  an  outlet  at  the 
bowels,  it  may  be  well  to  institute  the  enquiry  how  these  dis- 
charges influence  the  disease.  However  absurd  the  pre- 
scription, urine  constitutes  a popular  cathartic  for  the  infan- 
tile age,  and  repeated  experiments  have  proved,  that  a moder- 
ate quantity  will  operate  upon  the  adult. 

It  can  hardly  be  possible  that  the  neutral  salts,  contained 
in  these  evacuations,  should  not  have  the  same  effect  upon  the 
intestinal  membranes,  whether  received  through  the  medium 
of  their  exhalents  or  the  stomach.  If  so,  they  must  be  both 
cause  and  effect  in  keeping  up  the  disease,  especially  acting 
upon  the  predisposed  tissue  of  this  membrane,  which  on  that 
account  requires  a much  less  dose  of  a cathartic  to  operate  than 
in  health.  Would  not  these  discharges,  acting  upon  the 
highly  susceptible  bowels,  like  other  cathartic  mixtures,  in- 
duce vomiting  by  the  irritation  they  produce  ? These  dis- 
charges would  appear  to  be  a sufficient  cause  to  account  for 


52 


Spencek  on  Asiatic  Cholera. 


this  stage  running  so  soon  and  certainly  to  a fatal  termina- 
tion, unless  arrested  by  remediate  means.  If,  then,  intem- 
perance and  filth  act  upon  the  same  organs  as  the  epidemic 
influence,  and  produce  a like  predisposition  ; and,  as  is  well 
known,  if  the  exciting  causes,  such  as  crude  food,  exposure 
to  cold,  cathartic  drugs,  or  fear,  are  either  sufficient  in  health 
to  produce  diarrhoea,  and  if  the  discharges  themselves  operate 
as  an  exciting  cause  in  perpetuating  the  disease,  do  we  need 
the  interposition  of  any  mysterious  agency  to  account  for  this 
stage  ? 

7.  Of  the  effects  upon  the  absorbent  system. — In  speak- 
ing of  the  extent  of  the  discharges,  it  was  mentioned  that 
from  twenty  to  fifty  pounds  were  occasionally  lost  in  the  pro- 
gress of  this  disease,  and  the  difference  in  the  weight  of  in- 
dividuals before  and  after  the  attacks,  has  proved  this  esti- 
mate within  bounds.  The  estimated  quantity  of  fluids  usual- 
ly circulating  in  the  heart  and  blood  vessels  is  from  twenty- 
eight  to  thirty  pounds.*  From  this  general  mass  the  large 
discharges  must  be  derived,  and  but  for  the  continuance  of  a 
function,  which  has  not  yet  been  taken  into  the  account,  the 
system  could  not  sustain  this  rapid  loss  of  fluids  for  an  hour. 

This  leads  me  to  the  consideration  of  a symptom  which 
has  been  looked  upon  and  described  as  peculiar  and  cha- 
racteristic of  this  disease,  viz.  extreme  emaciation  of  fea- 
tures. What  is  the  “ horrible  expression  of  countenance” 
so  vividly  described  ? Is  it  not  the  “facies  Hipocratica,” 
the  precursor  of  death  in  all  diseases  ? The  same  emaciation 
that  happens  in  typhus  in  a month,  or  that  occurs  in  the  hec- 
tic patient  after  a struggle  with  disease  for  years,  sometimes 
takes  place  in  the  epidemic  in  a few  hours.  The  bones  of 
the  face  are  almost  laid  bare,  and  there  is  often  added  to 
this  a dusky  brown  appearance  of  countenance , which  pre- 
sented in  the  form  of  disease,  and  appearing  as  a mysterious 
stranger,  no  one  not  steeled  to  the  impulses  of  humanity,  can 
for  the  first  time  view  without  horror.  But  this  duskv  or 


* Horner. 


Spencer  on  Asiatic  Cholera . 


53 


purple  appearance  of  the  surface  is  always  observable  when 
from  any  cause  the  function  of  the  lungs  is  interrupted,  and 
imperfectly  arterialized  blood  is  sent  to  the  surface,  and  ad- 
mits a ready  exposition  in  the  present  epidemic  from  the  cir- 
cumstance, that  on  dissection  even  the  arteries  are  often  found 
containing  the  same  dark  grumous  blood  as  the  veins. 

Rationally  to  account  for  the  rapid  emaciation,  recurrence 
must  be  had  to  some  of  the  established  laws  of  life  in  health 
and  disease.  In  the  organization  of  our  bodies,  two  sources 
of  nourishment  are  provided,  the  one  through  the  medi- 
um of  the  stomach  and  bowels,  the  other  the  system  itself. 
The  cellular  deposit  is  a reserve  of  nourishment,  and  the 
waste  of  one  part  frequently  supplies  the  wants  of  another. 
The  latter  sources  are  wise  provisions  of  Providence  to  en- 
able this  “ fearfully  and  wonderfully  made”  machine  to 
sustain  life  during  the  progress  of  disease,  when  the  ap- 
petite is  destroyed,  and  almost  every  source  of  nourishment 
is  cut  off  through  the  medium  of  the  stomach  and  intes- 
tines. The  powers  of  life  are  almost  wholly  sustained  by 
this  means  during  the  continuance  of  protracted  fevers,  and 
many  other  maladies.  In  health  all  parts  of  the  body  are  un- 
ceasingly undergoing  changes  of  waste  and  renovation,  so  that 
it  may  be  emphatically  said  that  man  is  not  the  same  ma- 
terial being  to-day,  that  he  was  yesterday.  In  the  present 
epidemic  we  have  found,  that  the  organs,  which,  in  health, 
are  constantly  supplying  the  blood  vessels  with  nourishment, 
are  rapidly  draining  the  heart  of  the  vital  fluids,  instead  of 
furnishing  their  usual  supply.  While  on  the  contrary,  the 
absorbents,  like  ten  thousand  pumps,  are  conveying  the  fat 
and  waste  parts  of  the  system  into  the  blood  vessels  to  sus- 
tain the  sinking  powers  of  life. 

8.  Of.  the  effects  of  the  discharges  upon  the  functions  of 
animal  life. — Hitherto  we  have  only  traced  the  effects  of  the 
large  discharges,  upon  the  functions  of  organic  life.  It  is 
now  proposed  briefly  to  examine  the  changes  observable  in 
those  organs  by  which  man  holds  communication  with  sur- 
rounding objects.  It  is  not,  however,  intended  to  trace  these 

8 


54 


Spencer  on  Asiatic  Cholera . 


effects  through  all  the  mysterious  operations  of  the  nervous 
system.  Appreciable  phenomena  are  all  that  it  is  intend- 
ed to  examine.  All  the  functions  of  life  seem  constantly 
balanced  by,  and  dependent  upon,  the  interposition  of  the 
nervous  system;  yet  too  little  is  known  of  its  operations  to 
make  them  the  foundation  of  pathological  doctrines.  In  thus 
speaking,  we  are  not  to  undervalue  the  recent  brilliant  discov- 
eries in  this  department  of  medical  science.  On  the  contra- 
ry, such  has  been  their  progress  as  almost  to  lead  to  the  in- 
dulgence of  the  hope  that  the  knife  of  the  anatomist,  aided  by 
the  light  of  physiology,  may  yet  demonstrate  the  connection 
of  the  operations  of  mind  with  the  mysterious  organization  of 
the  brain,  and  point  us  to  “ the  thin  partition,  thought  and 
sense  divide.” 

Dullness  of  intellect  generally  follows  as  an  effect  upon 
whatever  weakens  the  general  system.  The  heart  and  nerv- 
ous system  are  reciprocally  dependent  upon  each  other  for 
their  respective  functions,  and  whatever  reduces  the  amount 
of  arterialized  blood  sent  to  the  brain  would  impair  its  func- 
tion, and  seem  rationally  to  account  for  the  change  from  fear 
and  apprehension  in  the  patient  to  an  entire  indifference  as 
to  the  result. 

If,  however,  there  is  one  redeeming  feature  in  an  epidem- 
ic, which  thus  insidiously  and  suddenly  summons  man  to  his 
great  account,  it  may  be  found  in  the  circumstance  that  rea- 
son often  preserves  her  empire  to  the  last.  The  intellectual 
functions  being  seated  in,  and  perhaps  even  depending  upon 
the  mysterious  structure  of  the  brain,  this  symptom  conclu- 
sively demonstrates  that  the  organization  of  this  “ wonderful 
compages”  remains  unimpaired.  This  is  likewise  fully 
proved  by  the  record  of  dissections. 

Convulsive  and  spasmodic  affections  have  so  frequently  at- 
tended the  severe  forms  of  the  epidemic,  as  to  be  considered  by 
many  as  essential  parts  of  it,  and  to  constitute  a great  source 
of  danger.  This  belief  has  led  physicians,  to  overlook  the  es- 
sential parts  of  the  disease,  and  also  to  the  extensive  employ- 
ment of  opiates  for  the  relief  of  these  spasms  ; but  experience 


Spencer  on  Asiatic  Cholera. 


55 


has  proved  these  remedies  generally  injurious.  When,  how- 
ever, these  muscular  affections  are  severe,  and  greatly  harrass 
and  exhaust  the  enfeebled  patient ; or  when  spasms  affect  the 
respiratory  muscles,  they  may  become  sources  of  danger,  and 
call  for  remediate  agents.  Constitutional  peculiarities  appear 
greatly  to  influence  these  symptoms,  which  are  often  produc- 
ed in  irritable  habits,  by  whatever  makes  a strong  impres- 
sion upon  the  nervous  system,  and  they  are  concomitants  of 
numerous  other  diseases.  The  convulsions  in  this  epidemic 
soon  subside , leaving  the  senses  clear,  precisely  as  happens 
when  they  result  from  hemorrhage,  and  it  may  be  inferred 
that  they  arise  from  a like  cause.  Spasmodic  affections  occur 
in  two  opposite  conditions  of  system,  depending  upon  reple- 
tion or  depletion  of  the  vessels  of  the  brain  and  nervous  appa- 
ratus, a remark  which  has  come  to  us  from  Hippocrates,  and 
has  been  confirmed  by  universal  observation.  To  the  conclu- 
sion that  spasms  arise  from  depletion,  it  may  however  he  ob- 
jected that  they  sometimes  ensue  at  an  early  period,  and  before 
the  serous  evacuations  have  become  profuse.  This  is  suffi- 
ciently explanable  from  constitutional  idiosyncrasies,  but  an 
indirect  depletion  from  indigestion  or  mild  diarrhoea  has  gen- 
erally been  going  on  for  hours  or  days,  in  the  first  stage,  and 
before  spasms  supervene.  That  they  generally  result  from 
depletion  in  this  malady,  is  likewise  inferible  from  the  fact, 
that  spasms  and  convulsions  are  uniformly  observable  in  the 
last  struggles  of  animals  which  die  from  sudden  loss  of  blood  ; 
it  being  rational  to  conclude  that  they  might  equally  be  caus- 
ed from  a loss  of  serous  or  sanguineous  fluids  from  the  heart 
and  circulating  apparatus.  But,  if  spasms  result  from  the 
effects  of  the  large  discharges,  let  us  institute  the  enquiry, 
how  spasms  in  their  turn  influence  the  circulating  and  respi- 
ratory functions.  What  physician,  who  has  often  bled  his  pa- 
tients, has  not  at  times  seen  the  blood  trickling  slowly  from 
the  arm,  and  on  directing  his  patient  to  move  the  muscles  of 
the  hand,  observed  the  blood  spurt  several  feet  ? Who, 
that  has  exercised  himself  by  running,  but  has  felt  his  heart 
throbbing  powerfully,  and  his  breast  heaving,  respiration 


56 


Spencer  on  Asiatic  Cholera. 


keeping  pace  with  the  hurried  circulation  ? In  this  instance 
the  muscles  contracting  upon  all  the  small  veins,  ramifying 
by  innumerable  branches  among  the  fibres,  lessen  their  cali- 
bres, and  hurry  the  blood  back  to  the  heart,  stimulating  it 
to  redoubled  exertion,  and  the  lungs  to  a corresponding  ac- 
tion. The  patient,  in  the  epidemic,  often  lies  in  a half  dos- 
ing posture,  breathing  very  slowly.  Respiration  is  much 
under  our  voluntary  power.  On  the  supervention  of  spasms, 
the  patient  is  suddenly  roused,  and  calls  loudly  upon  the  by- 
standers to  use  friction  as  a mode  of  relief  for  his  sufferings. 
Can  any  one  doubt  that  spasms,  by  hurrying  the  blood  back 
to  the  heart  from  the  minute  veins,  and  by  rousing  the  patient 
to  voluntary  exertions  to  breathe,  contribute  to  aid  two  im- 
portant functions,  on  which  the  pabulum  of  life  unceasingly 
depends  ? 

Vomiting  was  found,  in  our  classification,  an  occasional , 
not  a constant  symptom,  and  only  occurs  in  this  stage  of  the 
malady.  It  is  an  exceedingly  common  symptom  in  all  in- 
testinal diseases.  Whatever  irritates  the  intestinal  tube,  gen- 
erally produces  it,  and  the  higher  the  irritation  is  applied,  the 
more  certainly  is  vomiting  induced.  In  colic,  the  spasmodic 
pains  seem  to  cause  it.  In  enteritis,  when  situated  high  up, 
the  irritation  is  such  as  uniformly  to  produce  this  symptom. 
Give  a drastic  cathartic,  its  operation  often  brings  on  vomit- 
ing. Peritoneal  inflammation  and  dysentery  frequently  pre- 
sent it  as  one  of  their  phenomena.  If  a person  lets  a billet 
of  wood  fall  upon  his  toe,  or  receives  a blow  upon  his  head, 
he  often  vomits.  Is  vomiting  an  essential  symptom  in  such 
cases  ? And  is  it  strange  that  crude  food,  fear  or  cathartic 
drugs,  acting  upon  the  highly  susceptible  intestinal  mem- 
brane, and  either  of  which  in  health  is  often  sufficient  to 
produce  this  symptom,  should  cause  vomiting  in  this  epidem- 
ic ? Is  it  an  essential  phenomena,  or  the  result  of  the  irritants 
thus  applied  to  the  bowels  ? When  a dose  of  emetic  tartar  is 
given,  the  stomach  generally  rejects  it,  but  if  not,  it  frequent- 
ly produces  severe  intestinal  discharges,  and  even  death.  A 


Spencer  on  Asiatic  Cholera. 


57 


large  dose  of  arsenic  is  sometimes  vomited,  and  tlie  patient 
thus  preserved  uninjured.  Can  any  one  doubt  that  vomiting 
is  a salutary  operation  of  the  system,  when  these  drugs  are 
taken  ? This  brings  me  to  the  consideration  of  the  effects  of 
the  operation  of  vomiting  upon  the  intestinal  discharges  in  the 
present  epidemic.  But  it  may  be  said  that  this  phenomenon 
should  have  been  considered  while  speaking  of  the  derange- 
ments of  the  viscera  of  organic  life,  the  stomach  being  one  of 
these.  In  the  first  stage,  we  found  disturbance  in  the  func- 
tions of  the  stomach,  and  gave  to  it  a full  share  of  considera- 
tion. Is  vomiting  deranged  function  ? The  muscular  sys- 
tem is  principally  engaged  in  this  operation,  and  it  certainly 
appears  proper  to  consider  it  in  this  place.  When  large 
serous  discharges  take  place  from  the  stomach,  it  is  ob- 
vious they  must  in  a great  measure  be  brought  to  that  organ 
by  an  inverted  motion  of  the  bowels,  and  have  come  from 
their  exhalents.  In  this  case,  the  mere  action  of  vomiting 
which  is  induced  by  the  serous  discharges  unloading  the  blood 
vessels,  cannot  constitute  a source  of  danger.  It  can  hardly 
have  escaped  the  observation  of  any  physician  that  nausea 
and  ineffectual  retchings  always  greatly  depress  the  powers 
of  life,  while  active  vomiting  often  rouses  enfeebled  action,  as 
may  be  exemplified  by  a reference  to  its  effects,  while  a person 
is  bleeding.  If  vomiting  supervenes,  it  almost  always  ex- 
empts the  patient  from  swooning,  #and  when  this  occurs,  he  is 
always  suddenly  roused  by  the  supervention  of  vomiting.  In 
the  operation  of  vomiting  the  stomach  and  muscles  surround- 
ing the  abdominal  viscera,  are  all  thrown  into  powerful  ac- 
tion. We  generally  have  at  the  commencement  of  vomiting 
in  the  epidemic,  an  uncommon  agitation  in  the  bowels,  re- 
sembling the  swashings  of  water  in  an  agitated  barrel.  This 
indicates  that  the  bowels  are  thrown  into  spasmodic  action, 
and  that  the  stomach,  as  in  colic,  is  secondarily  drawn  into 
the  operation  of  vomiting. 

Diarrhceal  discharges  having  been  proved  to  come  from  the 
intestinal  exhalents,  it  is  now  proposed  to  trace  the  opera- 


58 


Spencer  on  Asiatic  Cholera. 


tion  of  vomiting  in  arresting  these,  bv  the  immediate  mechan- 
ical operation  of  the  contractions  and  their  effects  upon  the 
other  functions  of  life. 

We  have  already  alluded  to  the  pathological  fact,  that  in 
hemorrhage  the  discharges  come  from  the  exhalents,  and 
analogy  would  lead  us  to  the  belief,  that  the  same  circum- 
stances found  useful  in  bleedings,  would  act  a salutary  part 
in  arresting  diarrhoea.  In  hemorrhage,  nothing  is  found  more 
useful  than  muscular  contraction  of  the  part  from  which  such 
discharge  takes  place.  This  may  be  exemplified  by  a refer- 
ence to  uterine  hemorrhage;  and  to  the  utility  of  emetics 
in  bleedings  from  the  stomach  and  bowels,  to  be  more  fully 
noticed  in  the  treatment.  Compression  is  one  of  our  most 
efficient  means  of  arresting  hemorrhage.  In  the  disease  un- 
der consideration,  the  muscular  contractions  of  the  bowels 
would  make  direct  compression  upon  the  minute  vessels, 
ramifying  upon  their  surface.  Concurring  with  this,  the  con- 
tractions of  all  the  muscles  surrounding,  must  strongly  com- 
press the  abdominal  viscera,  and  must,  of  course,  produce  the 
same  mechanical  effect  upon  the  intestinal  exhalents,  as  in 
hemorrhage,  and  directly  tend  to  arrest  their  discharges.  Hav- 
ing traced  the  effects  of  vomiting  upon  the  arterial  circula- 
tion in  the  bowels,  let  us  turn  our  attention  to  its  effects  upon 
the  venous.  Compression  has  always  been  deemed  one  of 
our  most  efficient  agents  in  promoting  venous  absorption. 
We  have  already  alluded  to  the  effects  of  muscular  contrac- 
tions in  hurrying  the  blood  from  the  minute  ramifications  of 
the  veins  in  their  interstices.  These  intestinal  contractions, 
and  the  compression  from  vomiting,  must  rapidly  hurry  the 
blood  in  the  intestinal  veins.  Where  do  these  go?  To  the 
liver  ; and  the  direct  effect  of  this  would  be  to  rouse  the 
action  of  an  organ  whose  function  has  been  from  the  first 
dawnings  of  the  disease,  suspended.  Active  emesis  some- 
times restores  the  secretion  of  bile,  and  the  concurrent  testi- 
mony of  the  whole  profession  proves  the  patient  safe,  when 
this  secretion  returns.  (See  cases  3 and  4.  Appendix.) 


Spencer  on  Asiatic  Cholera. 


59 


It  is  generally  the  case  when  an  emetic  is  exhibited  in  other 
diseases,  that  no  bile  is  ejected  until  the  patient  has  vomited 
several  times.  May  we  not  conclude  that  the  action  of  vom- 
iting, in  such  cases,  hurries  the  blood  from  the  intestines,  and 
thus  promoting  the  biliary  secretion,  this  fluid  comes  at  last 
to  be  discharged  ? It  may  be  said  that  compression  of  the  gall- 
bladder will  account  for  this  discharge,  but  it  is  at  times  al- 
together too  profuse  to  admit  of  such  an  explanation.  In 
jaundice  and  other  diseases,  with  deficient  biliary  secretion, 
all  experience  proves  emesis  one  of  the  most  efficient  agents 
for  its  restoration.  Upon  the  function  of  respiration , vom- 
iting cannot  be  an  inert  agent.  The  diaphragm  and  abdom- 
inal muscles  which  are  so  actively  employed  in  vomiting,  con- 
stitute an  important  part  of  the  muscular  apparatus  for  breath- 
ing, and  their  spasmodic  contractions  must  rouse  the  patient 
and  hurry  respiration.  Upon  the  heart  and  circulation,  it 
cannot  be  a passive  agent.  The  contractions  of  such  an  as- 
semblage of  muscles,  and  the  compression  of  all  the  abdomi- 
nal viscera  must,  from  all  these  sources,  hurry  back  the  blood 
to  the  heart,  distending  and  rousing  this  organ,  enabling  it  to 
give  a centrifugal  direction  to  the  fluids,  which  being  thus 
vigorously  directed  to  the  lungs  and  extreme  parts,  promote 
warmth,  and  induce  free  diaphoresis.  If  the  suppression  of  cu- 
taneous perspiration  acts  a prominent  part  in  exciting  the  ep- 
idemic, it  would  be  absurd  to  believe  that  its  restoration  would 
not  have  a direct  effect  in  arresting  the  intestinal  discharges. 
If  the  above  exposition  of  the  pathology  of  vomiting  should 
be  rejected,  universal  observation  has  at  least  established  the 
intimate  relation  of  cause  and  effect  between  vomiting:  and 
sweating,  and  from  this  alone  might  be  deduced  the  utility  of 
free  emesis  in  restoring  the  lost  balance  of  cutaneous  and  in- 
testinal exhalation  in  the  present  epidemic.  If  then,  emaci- 
tion,  spasms  and  vomiting,  in  this  stage  of  universal  commo- 
tion, perform  these  salutary  operations,  instead  of  being  alarm- 
ed, should  we  not  welcome  their  appearance  as  lending  their 
aid  in  restoring  the  lost  balance  of  the  functions,  and  in  re- 
pelling the  invasions  of  a foe  that  has  in  the  first  period  of  the 


60 


Spencer  on  Asiatic  Cholera. 


epidemic  insidiously  made  his  approaches  almost  to  the  cita- 
del of  life. 

Recapitulation. — From  a review  of  what  has  been  ad- 
vanced on  the  nature  of  the  second  stage,  its  essential  pathol- 
ogy may  be  summed  up  in  a few  propositions. 

1.  The  disease  essentially  consists  in  this  stage,  in  a deter- 
mination of  fluids  to  the  inner  surface  of  the  small  intes- 
tines, diverting  the  respiratory,  perspiratory  and  urinous  dis- 
charges, with  their  neutral  salts,  from  their  usual  channels ; 
and  discharging  them  through  the  intestinal  exhalents , rapid- 
ly emptying  the  blood  vessels  of  their  contents,  and  changing 
the  relative  proportions  of  the  remnant  of  circulating  fluids. 

2.  That  the  failure  of  the  functions  of  the  heart,  lungs, 
capillary  circulation,  and  various  secretions,  results  from  di- 
rect depletion,  depriving  those  organs  of  their  accustomed 
stimulus. 

3.  The  absorbent  system  is  rapidly  taking  up  the  adipose 
and  waste  parts  of  the  body,  to  supply  the  failing  resources  of 
the  heart,  and  thus  results  the  rapid  emaciation. 

4.  The  spasms  of  the  voluntary  muscles,  and  those  drawn 
into  contractions  in  the  act  of  vomiting,  by  compressing  the  in- 
testinal exhalents,  tend  to  arrest  the  discharges  ; and  by  aiding 
the  return  of  the  venous  circulation,  stimulate  the  heart  to 
redoubled  exertion,  giving  a centrifugal  direction  to  the  cir- 
culation, thereby  making  a metastasis  of  the  exhalation  from 
the  inner  surface  of  the  bowels  to  the  skim 

5.  That  a striking  analogy  exists  between  this  disease  and 
hemorrhage,  differing  only  in  its  effects  upon  the  constitu- 
tion, from  the  circumstance  of  its  changing  the  relative  pro- 
portions of  the  ingredients  of  the  blood. 

CHAPTER  V. 

OF  THE  PATHOLOGY  OF  THE  THIRD  STAGE. 

( a)  Collapse  constitutes  the  leading  feature  in  the  latter 
stage  of  all  diseases.  The  character  of  this  is  varied  accord- 


Spencer  on  Asiatic  Cholera. 


61 


ing  to  the  nature  of  the  disease  from  which  it  results,  being  in 
some  diseases  sudden,  in  others  gradual.  In  all  cases,  it  is 
produced  by  the  prostration  of  the  vital  energies — and  two 
general  causes  induce  it.  One  is  disorganization  of  some 
important  organ  on  whose  function  life  depends;  and  the  oth- 
er is  debility,  from  whatever  lessens  the  volume  of  circulat- 
ing fluids.  The  latter  may  take  place  gradually  or  suddenly. 
From  what  has  been  said  on  the  nature  of  the  second  stage,  it 
is  obvious  that  the  collapse  here  must  result  from  direct  deple- 
tion. This  stage  appears  to  be  the  last  resource  of  the  system, 
to  restore  the  lost  balance  of  the  functions,  and  the  discharges 
cease  from  the  failure  of  the  circulation,  precisely  as  in  the 
collapse  in  hemorrhage. 

Debility , not  disease , must,  therefore,  be  the  leading  char- 
acteristic of  this  stage.  The  blood  vessels  not  being  able  to 
contract  down  upon  their  contents  as  rapidly  as  they  are  emp- 
tied, fainting,  and  all  the  usual  symptoms  of  collapse,  from  he- 
morrhage* present  themselves.  Some  shades  of  difference 
are  observable,  but  the  leading  phenomena  are  the  same.  The 
dusky  brown  appearance  of  the  surface  is  more  remarkable  in 
the  epidemic  than  in  hemorrhage,  and  is  what  should  be  ex- 
pected from  changes  taking  place  in  the  relative  proportions 
of  the  ingredients  of  the  blood  ; the  neutral  salts  having  been 
most  satisfactorily  proved  by  Dr.  Stevens,  essential  to  its  due 
arterialization.  More  of  the  colouring  matter  of  the  blood 
remaining  in  the  epidemic  than  in  hemorrhage,  and  this 
fluid  not  undergoing  the  usual  change  in  the  lungs,  is  of  course 
sent  back  to  the  surface  of  a darker  colour,  giving  this  tinge 
to  the  skin. 

The  skin  is  frequently  morbidly  sensible. — This  circum- 
stance appears  to  result  from  the  extreme  coldness  of  surface, 
and  resembles  the  same  phenomenon  arising  from  exposure 
to  a cold  atmosphere,  or  the  other  means  of  lessening  the  an- 
imal temperature. 

Convulsive  breathing , by  no  means  confined  to  this  disease, 
undoubtedly  results,  at  times,  from  spasm  of  the  respiratory 

9 


62 


Spencer  on  Asiatic  Cholera. 


muscles.  It  is,  however,  an  exceedingly  common  symptom 
in  asphyxiated  conditions  of  the  system,  and  in  this  disease 
the  deprivation  of  the  blood  of  its  ordinary  aqueous  and  saline 
ingredients,  prevents  its  undergoing  the  usual  changes  in  the 
lungs. 

Cold  tongue  and  cold  breath , being  common  symptoms,  in 
all  cases  of  collapse,  demand  no  special  notice  ; obviously  re- 
sulting from  failure  of  the  capillary  circulation  of  the  tongue 
and  lungs. 

Intense  thirst  is  more  remarkable  in  this  disease  than  al- 
most any  other.  An  instinctive  desire  for  drinks,  always  re- 
sults from  whatever  deprives  the  blood  of  its  fluid  ingredients. 

The  internal  heat,  of  which  the  patient  complains  in  this 
stage,  has  led  to  the  belief,  that  there  was  internal  inflamma- 
tion, and  the  remedies  employed  in  that  disease  have  been 
put  in  requisition  in  this  stage.  From  the  known  effects, 
however,  of  depleting  remedies  in  inflammation,  its  continu- 
ance would  seem  impossible  in  this  stage.  Our  sensations  of 
heat  are  always  relative,  depending  upon  the  degree  to  which 
a part  had  been  previously  subjected.  The  cold  tongue,  cold 
breath,  and  hot  injections  coming  away  cold,  go  conclusively 
to  prove  that  the  internal  parts  participate  in  the  same  gener- 
al failure  of  the  capillary  circulation  as  the  surface,  a condi- 
tion incompatible  with  the  continuance  of  inflammation. — 
This  sensation  of  internal  heat  must,  therefore,  be  referred  to 
deranged  sensation  of  the  patient. 

The  moist  tongue,  its  vessels  being  entirely  uninjected,  and 
the  same  condition  of  the  lips,  all  disprove  the  continuance  of 
inflammatory  disease.  To  these  evidences  may  be  added  the 
appearances  on  dissection,  which  exhibit  no  lesions  in  any  de- 
gree, when  the  patient  suddenly  dies  in  collapse.  It  is  thought 
fairly  inferible,  from  all  that  has  preceded,  that  death,  under 
these  circumstances,  results  from  depletion,  and  that  the  so- 
lid organism  of  the  body  remains  entire,  requiring  nothing  but 
circulating  fluids  to  keep  up  the  functions  of  life.  If  this  be 
so,  we  should  naturally  infer,  that  animation  may  be  for  a 


Spencer  on  Asiatic  Cholera.  6S 

time  suspended,  and  the  vitality  of  the  blood  vessels  remain- 
ing,  by  contracting  down  upon  their  contents,  might  subse- 
quently set  the  machinery  of  life  in  motion,  and  the  patient  be 
thus  resuscitated.  Facts  sustain  this  conclusion.  In  answer 
to  a circular,  inviting  information  on  this  subject,  Professor 
Potter,  of  Baltimore,  says  : “ I saw  no  case  of  apparent  death 
from  collapse,  followed  by  convalescence,  though  I have  learn-  , 
ed,  from  high  medical  authority,  that  two  cases,  apparently 
dead  from  collapse,  were  resuscitated.  They  are  now  in  good 
health.  I have  seen  them  both  within  the  last  week.”  Dr. 
Noyes  Palmer,  of  Cayuga,  remarks  : “ that  two  had  recover- 
ed from  apparent  death,  one  of  whom  was  actually  laid  out 
upon  the  board,  and  the  coffin  preparing.”  Dr.  Lyman  Cla- 
ry, of  Salina,  remarks : c:  I saw  a child,  three  years  old,  in 
which,  at  two  hours  from  the  attack,  respiration  and  pulsation 
ceased ; the  child  was  laid  by,  and  a shroud  prepared.  Some 
hours  after,  the  child  was  perceived  to  move,  and  recovered 
so  as  to  call  its  mother  bv  name.  It  died,  however,  about 
fourteen  hours  from  the  attack.”  Alderman  Barnes  and  Mr. 
Gore,  of  New-York,  mentioned  two  cases  of  the  kind  within 
their  knowledge,  one  of  whom,  a woman,  was  apparently 
dead  from  an  hour  to  an  hour  and  a half,  and  subsequently  re- 
covered. The  other  case  was  a man,  who  was  apparently 
dead  for  a longer  period,  afterwards  revived,  but  subsequent- 
ly died  of  consecutive  fever.  Alderman  Coxe,  of  the  same 
place,  mentioned  to  me  that  there  were  some  cases  in  the  Belle- 
vue alms  house,  that  were  apparently  dead  for  several  hours, 
and  afterwards  recovered. 

In  the  Cholera  reports  of  Hospital  Physicians,  New- 
York,*  Dr.  Cod  wise  remarks  : “ about  5 o’clock  I thought 
my  patient  dead ; it  was  after  an  attempt  to  raise  her  head, 
that  she  might  swallow  some  chicken  tea”  ; “ she  lay  some- 
time breathless,  pulseless  and  motionless.”  She  recovered. 

The  vitality  of  the  absorbents  continuing  after  apparent 
death,  may  likewise  contribute  to  the  resuscitation  of  the  pa- 


* Page  171. 


64 


Spencer  on  Asiatic  Cholera. 


tient,  by  supplying  the  blood  vessels  with  aqueous  and  saline 
ingredients.  Dr.  Isaac  Hays,  in  an  able  lecture  u on  the 
Pathology  of  Cholera,”*  remarks  : “ The  functions,  it  is 
known,  do  not  all  cease  together  : the  organs  die  in  succession. 
The  function  of  absorption  is  among  the  last  to  die  ; it  often 
continues  hours  after  the  external  phenomena  of  life  have 
ceased.  In  one  specimen  of  blood,  taken  from  a cholera  sub- 
ject, some  time  after  death,  M.  Lassaigne  found  nearly  the 
same  quantity  of  serum  that  is  contained  in  healthy  blood. 
Mr.  Prater  says,  that  sometimes  in  cholera,  the  circulation 
begins  after  respiration  has  ceased,  the  person  being  apparent- 
ly dead.”  Should  not  such  attempts  at  reaction,  or  those  in 
which  warmth  returns,  or  strong  muscular  movements  are 
observed,  after  apparent  death,  be  aided  by  the  same  means  of 
resuscitation,  as  when  it  happens  from  drowning,  or  sudden 
hemorrhage  ? 

(h J Reaction  in  this  disease  does  not  materially  differ  from 
that  which  takes  place  when  the  system  rallies  from  sudden 
collapse,  resulting  from  any  other  cause  ; and  when  irregular 
actions  of  the  various  organs  occur,  from  having  been  in  a 
state  of  previous  inactivity,  it  should  not  be  regarded  in  the 
light  of  confirmed  disease.  It  presents  considerable  variety 
in  the  phenomena,  demanding  in  this  place  no  remarks  upon 
their  pathology.  From  what  precedes,  maybe  briefly  deduc- 
ed the  pathology  of  collapse. 

1.  That  it  consists  in  direct  debility  and  failure  of  the 
functions  of  life,  caused  by  the  sudden  loss  of  the  stimulus  of 
distention  of  the  heart  and  blood  vessels,  which  do  not  rea- 
dily contract  down  upon  their  contents. 

2.  The  qualities  of  the  blood  are  changed,  from  the  previ- 
ous dischage  of  some  of  its  elements,  while  the  others  are 
retained. 

( c)  Pathology  of  the  fourth  stage. — The  fourth  stage  con- 
sists essentially  in  fever  of  a low  type,  to  which  is  often  ad- 
ded local  disease.  Considering  this  a distinct  form  of  disease, 

* Read  before  (he  Philadelphia  Medical  Societv.  Cholera  Gazette,  21rt  Nor, 
1.832,  page  242. 


Spencer  on  Asiatic  Cholera . 


65 


and  the  pathology  of  fever,  being  foreign  from  my  present 
subject,  it  will  not  he  here  considered ; although  the  reme- 
dies thought  best  adapted  to  this  period,  will  in  their  proper 
place  be  noticed. 


CHAPTER  VI. 

iOF  THE  PATHOLOGICAL  RELATIONS  AND  COMPLICATION  OF 
DIARRHOEA  SEROSA,  WITH  OTHER  DISEASES. 

1.  Of  its  relations  to  other  forms  of  diarrhoea. — It  must 
be  evident,  from  what  was  said  upon  the  origin  of  the  serous 
discharges  in  the  epidemic,  (see  chap.  IV.  1)  that  all  dis- 
charges coming  from  the  intestinal  tube,  must  be  composed  of 
hemorrhagic,  serous,  or  mucous  injesta  or  feculent  matter,  or 
a compound  of  these,  and  which  would  of  course  vary  the  ap- 
pearance of  the  evacuations.  It  is  here  proposed  to  examine 
the  several  varieties  of  diarrhoea,  with  a view  to  determine 
what  constitutes  the  source  of  danger  in  each. 

(a)  u Diarrhoea  Biliosa'1'’ — “ Foeces  loose,  copious,  and  par- 
ticularly yellow.” — (Good’s  Nosology.)  In  this  variety, 
there  is  evidently  an  increased  secretion  of  bile,  the  natural 
cathartic  of  the  system.  If  this  were  discharged  into  the  in- 
testines, in  too  large  quantity,  what  should  we  expect  ? The 
specific  action  of  cathartic  drugs  being  to  act  upon  the  intes- 
tinal exhalents,  would  excite  serous  discharges,  which  would 
wash  out  the  bile  from  the  bowels,  in  the  form  of  copious 
yellow  stools.  Suppose,  however,  this  proceeded  so  far  as  to 
endanger  the  system,  from  the  extent  of  the  discharges^  what 
would  happen  ? The  rapid  drain  of  fluids  into  the  inner  sur- 
face of  the  bowels,  by  cutting  off  the  return  of  blood  to  the 
liver,  through  the  portal  veins,  would  suspend  the  secretion 
of  bile,  and  the  discharges  would  at  last  come  to  be  devoid  of 
this  fluid.  Observation  proves  this  to  be  the  general  termin- 
ation of  bilious  diarrhoeas.  It  must,  therefore,  be  concluded, 


66 


Spencer  on  Asiatic  Cholera. 


that  if  any  danger  results,  the  serous  and  saline  matters  dis- 
charged, must  constitute  its  source. 

(b ) “ Diarrlma  mucosa. — The  discharges  consisting  of,  or 
containing  a copious  discharge  of  mucous.” — (Good.)  This 
form  of  diarrhoea  evidently  consists  of  a compound  of  serous 
and  mucous  discharges,  and  as  mucous  is  secreted  from  glands 
which  always  perform  a slow  elaboration  from  the  blood,  it 
must  be  evident  that  any  pressing  danger  in  this  variety  must 
result  from  the  serous  part  of  the  discharge. 

(cj  “ Diarrlma  Caliaca — discharge  of  a milky  humor, 
like  chyle.'” — (Cullen’s  Nosology.)  Of  this  variety  we  have 
already  spoken,  while  treating  of  the  epidemic,  where  it  was 
found  that  the  serum,  with  which  the  chylous  fluid  was  mix- 
ed, constituted  the  principal  source  of  danger. 

(d)  “D  iafrhcea  Lienteria — the  food,  without  any  material 
change,  quickly  discharged.” — (Cullen.)  No  immediate 

danger  can  attend  this  form,  unless  serous  discharges  are  ex- 
cited. 

( c)  “ D.  Hcpatirrhota — discharge  of  a bloody  matter,  like 
serum,  without  pain.” — (Cullen.)  This  must  evidently  be 
a serous  discharge,  in  which  a few  of  the  red  globules  of  the 
blood  pass  off  with  the  serum,  as  often  happens  in  the  epi- 
demic, and  the  source  of  danger  the  same. 

(fj  “ Diarrlma  Fusa — (D.  Crapulosa  of  Cullen?)  faeces 
of  common  quantity,  but  immoderately  loose  and  copious, 
(stercoracea.)” — (Good.)  It  must  be  evident  that  this  is  the 
mere  washing  out  of  the  contents  of  the  bowels,  by  the  intes- 
tinal exhalents.  These  constitute  all  the  varieties  in  Cullen’s 
and  Good’s  Systems  of  Nosology  ; and  it  must  be  obvious  that 
serous  discharges  are  the  only  source  of  danger  in  all.  A set 
of  nosological  names  for  these  varieties  of  diarrhoea,  pointing 
to  the  serous  part  of  the  discharges,  as  the  important  cir- 
cumstance, and  to  the  various  colours,  &c.  as  accidental  coin- 
cidences, would  appear  to  be  a desideratum.  The  analogy  of 
hypercatharsis  to  the  epidemic,  has  already  been  traced,  and 
the  train  of  symptoms  resulting  found  similar.  It  now  re- 
mains to  trace  the  pathological  relations  of  the  epidemic  to 


Spencer  on  Asiatic  Cholera.  67 

cholera  morbus,  a disease  with  whicli  it  has  been  unfortun- 
ately confounded. 

(g)  Cholera,  as  defined  from  Cullen,  (see  page  219)  con- 
sists essentially  in  its  first  onset,  of  vomiting  and  purging,  ex- 
cited by  bilious  matter,  from  which  the  name  of  the  disease 
is  derived.  This  is  essentially  a disease  of  warm  weather 
and  warm  climates,  which  either  by  producing  a change  in 
the  mass  of  circulating  fluids,  or  operating  upon  the  function 
of  the  liver  itself,  produce  a change  in  the  properties  of  the 
hepatic  secretion,  and  induce  an  augmentation  of  its  usual 
quantity.  Now,  what  are  the  usual  properties  of  bile  ? Ca- 
thartic. If  the  quantities  of  this  become  acrid,  what  should 
he  expected  ? The  same  as  from  the  operation  of  any  irritating 
cathartic  drug,  which  always  produces  catharsis,  and  often 
emesis.  If  the  bile  is  not  very  acrid,  it  excites  bilious  di- 
arrhoea, but  if  vomiting  happens,  the  disease  is  at  once  chris- 
tened with  the  name  of  “ cholera.”  In  this  disease,  is  vomit- 
ing an  essential  symptom,  or  does  it  result  from  irritation  of 
the  intestines,  by  the  sympathetic  relations  existing  between 
them  and  the  stomach,  as  in  other  diseases  of  the  bowels  ? 
Let  us  examine  the  progress  of  this  disease,  and  see  whether 
it  becomes  hazardous,  from  the  same  cause  as  the  other  in- 
testinal diseases  already  noticed.  If  the  disease  advances  to 
a fatal  stage,  we  have  large  watery  stools,  which  lose  their 
bilious  tinge,  and  as  the  consequence,  if  the  case  prove  fatal, 
cramps,  low  voice,  profuse  sweating,  &c.  as  in  the  epidemic, 
or  in  any  disease  attended  with  hemorrhagic  or  other  large 
discharges.  Here,  then,  appears  to  be  a train  of  symptoms, 
showing  an  intimate  pathological  relation  to  the  epidemic  in 
the  latter  stages.  These  large  serous  discharges,  in  the  lat- 
ter period  of  common  cholera  morbus,  must  evidently  come 
from  the  intestinal  exhalents,  and  death  must  be  produced  in 
the  same  manner  as  in  any  of  the  diarrhoeal  discharges,  whe- 
ther natural  or  artificial.  Vomiting  generally  ceases  in  the 
latter  periods  of  common  cholera,  and  the  serous  discharges 
constitute  the  only  source  of  danger.  This  disease,  then, 
bears  an  entire  analogy  to  hypercatharsis  from  active  drugs, 


I 

6S  Spencer  on  Asiatic  Cholera. 

and  the  name  “ cholera,”  is  most  unfortunate,  since  it  has 
become  so  much  associated  with  our  ideas  of  vomiting  and 
morbid  bile,  as  the  source  of  mischief,  that  the  serous  di- 
arrhoea excited  is  overlooked,  and  thus  becomes  the  insidious 
outlet  of  life.  Common  cholera  morbus  should  be  considered 
as  bearing  the  same  pathological  relations  to  bilious  diarrhoea, 
as  the  severe  forms  of  the  epidemic  to  the  diarrhoea  serosa, 
which  is  always  a much  more  dangerous  disease  than  the 
bilious.  It  must  be  evident,  from  what  precedes,  that  the 
source  of  danger  in  all  these  intestinal  diseases,  is  the  same, 
whether  resulting  from  morbid  bile,  cathartic  drugs,  irritating 
food,  or  the  epidemic  influence  ; no  hazard  attending  either, 
except  from  the  serous  and  saline  discharges.  And  hence  it 
is,  that  the  term  cholera,  in  medicine,  is  most  unfortunate, 
since  it  is  merely  applied  to  the  aggravated  forms  of  these 
complaints. 

(h ) The  operation  of  emetic  tartar , when  it  produces  lit- 
tle vomiting,  is  generally  that  of  a severe  cathartic,  and  it  can 
scarcely  have  escaped  the  observation  of  the  experienced  phy- 
sician, that  the  train  of  symptoms  resulting  from  the  opera- 
tion of  this  drug,  often  simulate  in  a striking  manner  the  epi- 
demic. Where  death  is  the  consequence,  may  we  not  be- 
lieve it  principally  results  from  this  drain  from  the  intestinal 
exhalents  ? 

2.  Of  the  complications  of  serous  diarrhoea,  with  other 
diseases. — (a ) Dysentery , although  an  inflammatory  disease 
of  the  mucous  tissue  of  the  large  intestines,  is  believed  to  be 
often  complicated  with  serous  discharges,  which  add  greatly 
to  the  hazard  of  the  malady.  This  complication  becomes  a 
matter  of  practical  importance,  requiring  the  resulting  indica- 
tions to  be  placed  upon  a rational  basis.  During  the  prevalence 
of  dysentery,  as  an  epidemic,  I have  observed  cases  of  a sud- 
denly severe  character,  in  which  large  watery  evacuations 
supervened,  vomiting  was  a frequent  concomitant,  and  as  the 
disease  advanced,  the  tormina  and  tenesmus  eeased,  and  the 
patient  sunk  rapidly  into  collapse  and  death.  A case  of  this 
description,  made  a strong  impression  upon  my  mind  in  1S30. 


Spencer  on  Asiatic  Cholera . 69 

A young  lady,  aged  15,  of  strong  constitution,  was  taken  with 
severe  symptoms  of  dysentery  ; soreness  of  the  abdomen,  mu- 
cous and  bloody  stools,  severe  tormina  and  high  fever  usher- 
ing in  the  complaint.  The  exhibition  of  a dose  of  castor  oil, 
seemed  to  be  the  exciting  cause  of  a sudden  change — large 
watery  stools  and  vomiting  supervened,  the  mucous  and  san- 
guineous dejections,  and  the  tormina  ceased,  rapid  sinking  of 
the  pulse,  marble  coldness  of  the  surface,  profuse  sweating, 
and  corrugated  hands  came  on,  soon  terminating  in  death.  On 
witnessing  the  entire  similarity  of  symptoms  in  the  fatal  cases 
of  the  late  epidemic,  it  recalled  this  and  other  similar  cases 
to  my  recollection,  and  I am  satisfied  that  it  must  have  been 
no  uncommon  complication,  notwithstanding  my  attention  was 
never  before  directed  to  the  circumstance.  Dr.  Hodge,  who 
has  witnessed  the  prevailing  epidemic  in  India,  in  a lecture, 
on  the  disease  to  the  Philadelphia  medical  society,  mention- 
ed that  he  had  often  known  the  serous  discharges  to  supervene 
upon  dysentery,  when  this  disease  would  cease.  In  one  in- 
stance, he  remarked,  that  the  dysentery  returned  as  the  patient 
recovered.  In  these  cases,  the  rapid  evacuations,  from  the 
exhalents,  by  reducing  the  system  below  the  grade  of  inflam- 
matory action,  account  for  the  subsidence  of  the  dysenteric 
symptoms.  A striking  similarity  is  observable  in  these  two 
diseases,  in  relation  to  the  biliary  secretion,  which  is  absent 
in  both  ; and  its  return  is  among  the  most  favorable  symp- 
toms in  each.  During  the  prevalence  of  the  epidemic  last 
summer,  several  cases  occurred,  complicated  with  severe 
dysenteric  symptoms.  Six  cases  of  this  description  came  under 
my  care,  and  five  under  the  care  of  a professional  friend.  These 
all  readily  yielded  to  the  remedies  hereafter  recommended  for 
the  epidemic. 

(b ) Influenza  has  generally  preceded  the  invasions  of  the 
present  epidemic,  and  presents  an  interesting  association  with 
the  history  of  this  malady.  The  epidemic  predisposition  in 
the  influenza,  appears  to  be  thrown  upon  the  mucous  mem- 
brane of  the  lungs,  which  entirely  resembles,  in  its  organiza- 
tion,  the  structure  of  the  intestinal  membrane, 

10 


70 


Spencee  on  Asiatic  Cholera. 


(c)  Intermittent  and  remittent  fevers , are  often  compli- 
cated with  diarrhoea,  which  is  a cause  of  sudden  death  at 
the  close  of  the  paroxysm.  Having  for  several  years  past, 
practised  in  a fenny  country,  I speak  from  careful  observation, 
when  I declare  that  this  complication  has  constituted  almost 
the  entire  outlet  of  life  in  this  variety  of  febrile  diseases.  So 
suddenly,  at  times,  has  death  been  produced,  that  I have 
known  the  patient  walk  about  in  the  morning,  and  found  him 
in  fatal  collapse  at  night.  My  attention  was  early  directed  to 
this  complication,  yet  I have  the  painful  recollection  of  sever- 
al sudden  deaths  from  this  cause,  and  my  pupils  can  bear  tes- 
timony to  the  earnestness  with  which  I have  directed  their  at- 
tention to  this  point.  Although  not  mentioned  generally  by 
writers  as  a symptom  in  the  malignant  forms  of  intermittents 
and  remittents,  I strongly  suspect  many  of  the  cases  may  have 
been  complicated  with  diarrhoea,  which  contributed  to  their 
fatal  character.  The  train  of  symptoms  in  these  cases,  en- 
tirely simulate  those  of  the  epidemic  in  collapse. 

( d)  Measles , and  other  eruptive  diseases,  are  often  com- 
plicated with  diarrhoea,  which,  when  severe,  always  adds  to 
the  hazard  of  such  cases.  It  is  believed  that  this  complica- 
tion is  one  of  the  most  frequent  causes  of  retrocession  of  the 
eruption  of  measles,  which  is  always  attended  with  imminent 
danger. 

(e)  Typhoid  fevers  are  frequently  combined  with  watery 
discharges  from  the  bowels,  and  so  hazardous  are  they  consid- 
ered, that  one  writer*  on  this  disease  remarks  : “ I have  never 
lost  a patient  whose  bowels  continued  constipated  through  the 
whole  course  of  the  disease,  and  have  never  known  a fatal 
case  of  typhus  unattended  by  diarrhoea.”  Professors  Chap- 
man and  Jackson  of  the  University  of  Pennsylvania,  invite 
the  attention  of  their  pupils  in  the  most  urgent  manner  to  se- 
rous diarrhoea,  as  a source  of  danger  in  febrile  diseases. 

It  becomes  a matter  of  the  deepest  moment  to  the  interests 
of  humanity,  that  a more  efficient  means  of  curing  this  com- 
plication, than  that  too  often  pursued,  should  be  developed. 


* Dr.  Nathan  Smith. 


Spencer  on  Asiatic  Cholera. 


71 


Under  the  usual  modes  of  treatment,  by  checking  the  di- 
arrhoea with  opiates,  absorbents,  and  astringents,  perhaps  fol- 
lowed by  cathartics,  the  truce  is  often  illusory,  as  it  has  been, 
when  the  first  stage  of  the  epidemic  has  been  thus  treated, 
the  serous  discharges  bursting  forth  with  redoubled  force. 
When  the  diarrhoea  is  thus  checked  in  typhus,  and  the  skin 
remains  dry,  hemorrhage  from  the  nose,  or  fatal  coma  often 
supervenes.  Whether  the  remedies  hereafter  recommended  in 
the  epidemic  for  making  a metastasis  of  the  exhalation  from 
the  bowels  to  the  skin,  can  be  generally  extended  to  typhus 
in  its  advanced  stages,  observation  must  determine.  In  one 
case,  under  the  care  of  a neighboring  practitioner,  where  the 
disease  had  continued  between  twenty  and  thirty  days,  watery 
diarrhoea  had  become  a pressing  symptom.  In  consultation, 
an  emetic,  combined  with  sudorifics,  was  employed,  the  biliary 
secretion  soon  returned,  and  the  patient  recovered.  Much 
respectable  testimony  might  be  cited  in  favor  of  the  employ- 
ment of  emetics  in  the  advanced  stage  of  typhus,  and  I have 
in  a few  instances  derived  decided  advantage  from  their  use. 
Great  care  should  always  be  exercised,  carefully  to  distin- 
guish bilious  diarrhoea,  which  is  the  presage  of  recovery,  from 
watery  discharges,  which  are  an  unfavorable  omen  in  typhus. 
I cannot  close  this  branch  of  my  subject  without  warning  the 
medical  student  against  the  employment  of  active  cathartics, 
for  the  cure  of  such  cases. 

It  would  appear  from  all  that  has  been  said  on  the  pathol- 
ogy and  complications  of  diarrhoea  serosa,  that  little  danger 
need  be  apprehended  in  intestinal  diseases,  attended  with  dis- 
charges, except  these  come  from  the  mucous  glands  or  exha- 
lents  of  the  bowels.  When  the  mucous  tissue  is  the  seat  of 
disease,  the  alarm  is  at  once  given  by  the  severe  tormina 
present.  In  case  of  hemorrhagic  discharges,  the  colour  im- 
mediately arrests  the  notice  of  the  patient.  On  the  contrary, 
serous  discharges  being  frequently  unattended  with  colour  or 
pain,  are  often  overlooked  even  in  the  first  stage  of  the  ep- 
idemic, which,  from  the  universal  apprehension  it  has  pro- 


72 


Spencer  on  Asiatic  Cholera. 


duced,  it  would  be  supposed,  ought  promptly  to  invite  atten- 
tion to  its  attacks.  The  danger,  however,  does  not  appear 
to  be  confined  to  the  epidemic’s  terrific  career,  but  the  same 
disease  entwining  itself  with  a host  of  other  maladies,  be- 
comes the  sly  destroyer  of  human  existence. 


CHAPTER  VII. 

OF  THE  NAME  AND  DIAGNOSIS  OF  THE  EPIDEMIC. 

The  successful  practice  of  medicine  depends  upon  the 
early  and  correct  diagnosis  of  disease.  If  disease  advances 
toward  a fatal  termination,  great  difficulty  is  frequently  ex- 
perienced in  determining  its  precise  seat  or  nature,  which  can 
alone  guide  us  to  a rational  mode  of  treatment.  In  the  pre- 
sent epidemic  the  early  dawnings  of  the  complaint  have  been 
too  much  overlooked,  and  when  it  has  advanced  to  the  very 
verge  of  death,  the  term  “ cholera”  is  applied  to  it.  This  name 
might  have  answered  very  well,  if  it  had  been  applied  to  all 
the  periods  of  the  malady.  Its  derivation  would  appear,  how- 
ever, to  show  its  improper  application  to  a disease  in  which 
no  hile  is  present,  and  in  which  every  physician  hails  the  re- 
turn of  this  secretion  as  the  certain  presage  of  recovery. 
“ When  the  disease  first  broke  out  in  Sunderland,  the  reports 
contained  three  classes  of  affections,  diarrhoea,  mild  cholera, 
and  malignant  cholera,  the  cases  of  diarrhoea  being  four  or  five 
times  more  numerous  than  those  of  cholera.”  (Winslow.) 
Can  any  one  point  out  the  distinguishing  symptoms  of  these 
three  diseases  ? If  not,  then  should  they  be  regarded  as  one. 
The  same  manner  of  reporting  obtained  in  other  places  where 
the  epidemic  first  broke  out,  and  after  its  continuance,  the  mild- 
er cases  came  to  find  a place  in  the  “ cholera  reports .”  This 
had  a most  favorable  effect  upon  the  public  mind,  and  it  is  be- 
lieved shows  most  conclusively  that  there  is  no  line  of  demar- 
cation between  u diarrhoea,”  “ mild  cholera,”  and  “ malig- 


Spencer  on  Asiatic  Cholera. 


73 


nant  cholera,”  but  that  they  are  only  different  degrees  of  the 
sama*disease.  It  has  been  proved  that  the  proximate  seat  of  dis- 
ease in  all  is  the  same,  and  it  is  hence  much  more  proper  to  call 
it  by  the  same  name  throughout.  What  name  should  be  select- 
ed, one  that  will  call  attention  to  its  essential  nature  in  every 
stage,  or  a name  applicable  to  none  ? Serous  diarrhoea  is  the 
first  stage  certainly,  and  it  may  be  well  to  enquire  when  the 
disease  should  be  called  cholera.  Shall  the  appearance  of 
vomiting  be  the  point  ? This  symptom  is  so  often  absent,  that 
diarrhcca  should  hold  the  precedence  in  numerous  cases 
throughout.  Indeed  vomiting  is  wanting  so  often,  and  es- 
pecially in  the  stage  which  should  invite  attention  from  cer- 
tainty of  cure,  that  it  is  exceedingly  improper  to  name  the 
disease  from  the  presence  of  this  symptom.  Spasms  are 
still  more  frequently  absent,  and  the  concurrent  testimony 
of  the  profession  goes  to  prove  that  the  patient  is  much  safer 
when  these  symptoms  are  present  than  absent,  conclusively 
showing  them  accidental  parts  of  the  disease.  The  epidemic 
generally  goes  on  for  several  hours  or  days,  when  crude  food, 
or  other  exciting  causes,  bring  on  the  severe  symptoms.  Does 
this  change  the  nature  or  degree  of  the  disease  ? If  degree 
only,  the  name  should  not  change.  But  it  may  be  said,  that 
vomiting  and  purging  sometimes  come  on  at  the  same  time. 
They  indeed  do,  but  the  patient  in  this  case  is  comparatively 
safe.  These  cases  are,  however,  unfrequent,  and  it  would 
be  obviously  much  more  proper  to  name  a disease  from  the 
the  nature  and  phenomena  generally  present,  than  to  take  the 
symptoms  of  rare  cases  for  that  purpose.  Indeed  the  serous 
discharges  are  here  the  only  sources  of  danger.  Physicians 
have  for  ages  believed  that  serous  diarrhoea  consisted  essen- 
tially in  an  exhalation  from  the  bowels.  It  has  been  proved 
that  the  same  seat  of  disease  exists  in  the  epidemic.  This  is 
an  old  name,  coming  to  us  from  remote  ages,  and  applies  to 
a prominent  symptom,  and  expresses  the  true  nature  of  the 
disease.  Shall  it  be  exchanged  for  any  of  the  numerous  mod- 
ern appellations  of  the  epidemic  ? The  same  error  of  designat- 
ing diarrhoea  by  the  name  “ cholera ,”  when  vomiting  su- 


74 


Spencer  on  Asiatic  Cholera. 


pervens,  has  come  down  to  us  from  ancient  times.  If  med- 
icine is  ever  to  take  its  place  among  the  certain  sciences,  it 
is  necessary  to  get  rid  of  some  of  the  vagaries  of  the  ancients, 
and  affix  a more  definite  idea  to  the  terms  employed. 

So  vaguely  has  the  term  cholera  been  used  by  ancient,  as 
well  as  modern  physicians,  that  it  would  be  most  fortunate 
if  it  could  be  excluded  from  all  nosological  arrangements  of 
disease,  as  it  is  from  that  of  Dr.  Young.  There  is  an  equal 
propriety  in  calling  the  collapse  of  fever,  or  any  other  disease 
cholera , as  to  apply  the  term  exclusively  to  this  stage  of  the 
epidemic.  And  if  the  occurrence  of  vomiting  is  to  be  the  pe- 
riod to  call  it  cholera,  then  may  a number  of  intestinal  dis- 
eases receive  the  application  with  equal  propriety.  It  is 
thought  the  epidemic  would  never  have  been  regarded  as  an 
aggravated  form  of  cholera,  but  for  vomiting  appearing  as  one 
of  the  occasional  symptoms  ; yet  this  phenomenon  is  a fre- 
quent concomitant  of  all  forms  of  diarrhoea,  and  generally  ap- 
pears in  the  latter  stage  of  the  chronic  disease  of  the  infantile 
age.  All  diseases  become  much  aggravated  by  becoming  ep- 
idemic, and  we  should  under  such  circumstances  expect  to 
find  an  augmentation  of  all  the  occasional  symptoms. 

Some  respectable  physicians  have  regarded  the  epidemic 
as  a malignant  form  of  fever,  but  the  essential  characteristics 
of  typhoid  fevers  are  wanting  in  the  three  first  stages.  In 
what  is  called  the  consecutive  fever,  this  is  undoubtedly  of 
the  typhoid  type,  but  this  is  a mere  accidental  sequel  of  the 
disease.  The  moist  tongue,  which  is  pale  at  its  edges,  the 
uninjected  condition  of  the  lips,  and  the  general  coldness  of 
skin  in  the  epidemic,  with  the  absence  of  coma  and  muscular 
debility,  sufficiently  distinguish  it  from  typhus. 

Common  cholera  morbus  is  the  only  disease  with  which 
it  has  been  confounded  to  any  considerable  extent,  and  the 
distinguishing  characteristics  of  the  two  complaints,  require 
to  be  carefully  traced. 


Spencer  on  Asiatic  Cholera. 


75 


The  epidemic  almost  univer- 
sally commences  with  diarrhoea, 
of  several  hours  or  days’  contin- 
uance. 

The  commencing  diarrhoea  of 
the  epidemic  is  devoid  of  bile. 

Water  is  the  principal  dis- 
charge in  the  early  period  of  the 
epidemic. 

If  bilious  discharges  come  on 
in  the  epidemic,  the  patient  is 
considered  safe. 

The  epidemic  as  well  as  the 
common  diarrhoea  is  a disease 
of  all  climates  and  all  seasons. 

Vomiting  is  by  no  means  a 
uniform  symptom  of  the  epidem- 
ic. 

The  epidemic  is  always  great- 
ly aggravated  by  changes  of  wea- 
ther from  warm  to  cold. 

In  the  epidemic,  the  hepatic 
function  is  suspended  from  the 
first  dawnings  of  the  disease. 


Cholera  morbus  is  scarcely 
ever  preceded  by  diarrhoea. 


If  diarrhoea  precedes  cholera 
morbus,  it  is  generally  bilious. 

Bilious  matter  is  the  principal 
discharge  of  cholera  in  its  early 
stage. 

If  the  bilious  discharges  cease 
in  common  cholera  and  watery 
stools  come  on,  there  is  great 
danger. 

Cholera  morbus  is  peculiarly 
a disease  of  hot  weather,  and 
warm  climates. 

In  common  cholera  vomiting 
is  a uniform  symptom,  when  ab- 
sent called  bilious  diarrhoea. 

Cholera  morbus  is  increased 
by  hot  sultry  weather  superven- 
ing upon  cool. 

In  common  cholera,  the  liver 
is  actively  excited  and  the  acrid 
bilious  matter  secreted  becomes 


But,  there  are  many  striking  resemblances  between  the 
two  diseases  in  the  advanced  stages,  as  has  been  noticed  un- 
der its  proper  head.  The  insidious  manner  in  which  the  ep- 
idemic advances,  undermining  the  constitution  for  a longer 
or  shorter  period,  in  the  first  stage,  giving  notice  of  its  attack 
by  scarce  a pain,  until  it  comes  suddenly  through  some  excit- 
ing cause  to  assume  the  appearance  of  common  cholera,  will 
explain  the  reason  for  the  error  that  has  been  transmitted  suc- 
cessively from  one  physician  to  another,  since  the  first  appear- 
ance of  the  disease  in  the  east,  a mistake  which  could  only  be 
corrected,  by  the  accumulated  observation  of  the  whole  pro- 
fession. 


76 


Spencer  on  Asiatic  Cholera . 


If  the  name  cholera  is  retained  to  designate  the  epidemic, 
it  should  be  the  name  applied  in  the  first  stage  of  the  disease, 
and  should  be  used  as  a synonymous  term  with  diarrhoea 
serosa,  and  treated  accordingly.  Considered  in  this  light, 
where  is  the  frightful  character  of  this  epidemic  ? It  only  be- 
comes dangerous  from  overlooking  the  first  stage,  which  is 
entirely  under  the  control  of  remedies.  What  is  it  that  has 
rendered  hydrocephalus  no  longer  one  of  the  opprobria  of  med- 
icine ? It  is  an  attention  to  the  symptoms  in  the  early  stage 
of  the  disease,  before  the  water  collects  in  the  brain,  at  which 
period,  “dropsy  in  the  head,”  like  “ cholera”  in  the  present 
epidemic,  is  synonymous  with  death.  The  conclusion  that  the 
universal  diarrhoeas  constitute  a part  of  the  same  general  ep- 
idemic, is  sustained  by  the  concurrent  testimony  of  the  medical 
profession,  with  many  of  whom  I have  correspended  through- 
out the  union,  all  which  goes  to  prove  that  these  discharges, 
with  few  exceptions,  have  been  of  the  same  character  as  those 
which  preceded  the  severe  forms  of  the  disease.  From  the 
same  source,  and  the  public  journals,  it  would  appear  that  the 
mortality  from  all  diseases  has  been  far  less  than  in  ordinary 
seasons.  It  hence  follows,  that  these  diarrhoeas,  according 
to  a long  observed  law  of  epidemic  maladies,  have  tended  to 
chase  off  other  diseases.  Notwithstanding,  then,  this  ep- 
idemic has  fallen  upon  some  localities,  with  the  impetuous 
rush  of  the  tornado,  may  it  not,  like  the  rains  of  heaven,  be 
regarded  as  a general  blessing  ? 


CHAPTER  VIII. 

OF  THE  NON-CONTAGIOUS  CHARACTER  OF  THE  DISEASE. 

Few  people  would  apprehend  the  slightest  danger  from 
common  diarrhoea  being  communicated  by  contagion,  but  dur- 
ing the  prevalence  of  this  disease,  even  medical  opinion  has 
been  divided,  and  it  may  therefore  be  deemed  expedient 


Spencer  on  Asiatic  Cholera.  7? 

briefly  to  notice  some  of  the  evidences  of  its  being  merely 
epidemic.  Diseases,  by  becoming  epidemic,  do  not  change 
their  essential  characters,  although  greatly  aggravated  during 
their  continuance  in  this  form.  If  we  regard  the  universal 
diarrhoea  as  a part  of  the  epidemic,  this  should  be  equally 
contagious  as  at  the  more  advanced  periods.  Now,  the  prev- 
alent diarrhoea  simultaneously  attacked  the  inhabitants  at  im- 
mense distances  from  each  other,  and  the  almost  entire  pop- 
ulation of  whole  towns  and  villages  were  affected  with  this 
mild  form  of  the  disease.  Contagious  complaints  generally 
attack  in  small  scouting  parties,  while  epidemics,  like  im- 
mense armies,  spread  simultaneously  over  immeasurable  tracts 
of  country*  The  progress  of  this  epidemic  has  been  regard- 
ed as  exceedingly  mysterious,  from  the  circumstance  of  its 
seemingly  contravening  the  established  law  of  these  dire  dis- 
eases. Considered,  however,  in  the  light  in  which  I have 
viewed  it,  the  mystery  vanishes,  since  the  universal  diarrhcea 
conforms  to,  instead  of  contravening  this  law.  The  severe 
grades  were  generally  confined  to  those  places  in  which  there 
was  a dense  population  ; and  a concentration  of  all  the  com- 
mon exciting  causes  of  diarrhcea,  sufficiently  accounts  for  the 
different  degrees  of  severity.  Its  following  the  great  thorough- 
fares has  likewise  been  adduced  in  favor  of  its  being  con- 
tagious ; but  these  rarely  pass  through  regions  of  country, 
thinly  inhabited  ; on  the  contrary,  through  dense  populations, 
which,  of  course,  sufficiently  explains  the  severe  disease  fol- 
lowing this  track.  The  rapid  spread  and  fatality  in  prisons 
and  alms-houses,  have  likewise  been  adduced  as  an  evidence  of 
its  contagious  character.  But  purely  contagious  diseases, 
have  never  been  known  to  disseminate  themselves  thus  rapid- 
ly, and  in  such  establishments  we  generally  have  broken 
down  constitutions,  and  a huddling  together  of  many  indi- 
viduals— always  a fruitful  source  of  diarrhoea,  which  is  in- 
deed readily  propagated  by  sympathy  and  panic.  The  fatal- 
ity in  some  of  these  places  has,  in  some  instances,  been  in  a 
great  measure  attributable  to  the  inmates  concealing  the  fact 

11 


TS  Spencer  on  Asiatic  Cholera. 

of  their  having  diarrhoea,  for  fear  of  being  sent  to  the  cholera 
hospital.  This  circumstance  happened  at  the  Walnut-street 
prison,  Philadelphia,  as  stated  to  me  by  Dr.  G.  W.  Norris, 
and  likewise  at  Bellevue  alms-house,  New-York,  mentioned 
by  Alderman  Coxe.  Is  it  rational  to  believe,  that  diarrhoea 
has  its  essential  character  changed,  by  becoming  epidemic, 
and  is  thus  rapidly  disseminated  by  contagion  ? Again,  con- 
tagious diseases  have  some  general  determinate  period  at 
which  they  attack  after  exposure,  and  the  disease  once  es- 
tablished will  almost  universally  go  through  its  several  stages, 
observing  regular  times  for  each.  If  this  epidemic  is  conta- 
gious, it  contravenes  both  these  laws,  since  the  rigid  observa- 
tion of  the  profession  would  have  determined  the  time  requir- 
ed after  exposure,  if  there  had  been  any  regularity,  and  all 
experience  proves  that  there  was  no  determinate  period  for 
its  duration,  different  cases  continuing  from  an  hour  or  two, 
to  a fortnight.  Contagious  diseases  rarely  recur,  while  this 
epidemic  would  often  return  on  the  slightest  application  of 
the  ordinary  exciting  causes.  This  disease  could  generally 
be  cut  short  when  attacked  with  appropriate  remedies,  en- 
tirely differing  in  this  respect  from  contagious  complaints, 
which  proceed  under  any  treatment.  Contagious  diseases  do 
not  require  the  influence  of  exciting  causes  to  develope  them. 
The  severe  form  of  this  disease  rarely,  if  ever,  attacked  any 
one  without  some  obvious  exciting  cause.  If  mild  diarrhcea 
is  not  contagious,  will  an  indigestible  meal,  exposure  to  cold, 
or  fear,  convert  it  into  an  infectious  disease  ? Physicians  in 
their  anxiety  to  develope  the  nature  of  this  malady,  have 
been  engaged  day  after  day  in  dissecting  those  who  have  died, 
and  notwithstanding  they  have  wounded  themselves  during 
those  investigations,  have  entirely  escaped  its  attacks.  The 
country  has  been  as  a whole,  much  healthier  during  the  pre- 
sent season  than  usual,  a circumstance  probably  resulting  from 
a known  law  of  epidemics,  which  chase  off  other  diseases. 
If  the  universal  diarrhoeas  are  not  to  be  considered  a part  of 
the  epidemic,  it  will  be  impossible  to  account  for  the  general 


Spencer  on  Asiatic  Cholera. 


79 


exemption  upon  this  principle ; the  severe  grades  having 
been  altogether  too  circumscribed  to  account  for  this  effect. 
Fevers  have  been  almost  chased  from  the  country.  This 
would  appear  to  be  the  result  of  some  general  pervading 
cause.  Epidemic  typhus  is  generally  preceded  by  the  same 
symptoms  of  indigestion,  which  mark  the  first  stage  of  the 
disease  under  consideration.  May  not  the  general  diarrhoea, 
by  preventing  the  improperly  digested  food  from  entering  the 
blood  vessels,  account  for  this  exemption  from  fevers  ? And 
may  not  the  same  general  cause  produce  all  epidemics,  which 
assume  different  characteristics  according  to  the  particular  or- 
gan or  tissue,  which  becomes  the  seat  of  predisposition  ? In- 
ferior animals  are  generally  exempt  from  the  contagious  dis- 
eases to  which  the  human  family  are  liable,  while,  on  the 
contrary,  they  are  subject  to  be  affected  by  epidemics,  as  has 
been  strikingly  exemplified  during  and  preceding  the  appear- 
ance of  this  diarrhoea.  From  the  close  analogy  which  this 
disease  bears  to  intestinal  hemorrhage,  the  proximate  seat 
being  the  same,  and  the  effects  on  the  constitution  alike,  we 
should  infer  that  their  general  characters  would  be  similar. 
No  one  entertains  a belief  in  the  contagious  character  of 
hemorrhage. 

It  may  be  said  that  whole  families  being  attacked  would 
indicate  its  spread  by  contagion.  To  this  it  may  be  answer- 
ed, that  all  are  of  course  subjected  to  the  same  atmospheric 
cause,  which  we  have  shown,  gives  a predisposition  to  be 
acted  upon  by  slight  exciting  causes,  to  which  they  are  gen- 
erally alike  exposed.  Not  only  so,  the  panic  has  in  many 
places  been  such  as  to  drive  every  neighbor  from  the  family, 
leaving  those  only  who  remain  well  to  perform  all  the  duties 
of  humanity  to  their  friends.  In  this  way  they  are  all  worn 
down  by  excessive  fatigue,  and  want  of  regular  meals.  If  to 
these  exciting  causes  we  add  grief,  fear,  and  despair  of 
remedy,  in  case  of  attack,  it  sufficiently  explains  such  occur- 
rences without  the  adventitious  aid  of  contagion.  It  may 
likewise  be  remarked,  that  those  who  went  among  the  dis-^ 


so 


Spencer  on  Asiatic  Cholera. 


eased  were  no  more  subject  to  the  attacks,  than  those  who  en- 
tirely avoided  exposure.  Indeed,  several  cases  occurred  un- 
der my  observation,  among  those  who  sedulously  avoided 
their  sick  neighbors,  becoming  the  ready  victims  of  the  dis- 
ease, while  not  a single  instance  of  death  occurred  among 
those  who  fearlessly  and  faithfully  performed  their  duty. 
Watchers  lay  down,  and  even  slept  on  the  same  bed  with  the 
sick,  without  contracting  the  disease.  The  same  thing  is 
mentioned  by  Broussais,  and  others,  where  the  experiment 
has  been  tried,  and  even  inoculation  has  not  been  found  to 
produce  the  disease. 

Physicians  and  nurses  have  been  no  more  subject  to  attack 
than  others.  The  evidence  of  the  disease  not  being  conta- 
gious must  rest,  of  course,  principally  upon  negative  ev- 
idence, which  may  be  abundantly  found  in  its  whole  history. 
During,  for  instance,  the  English  campaigns  in  India,  two 
regiments  being  for  a time  stationed  at  different  places,  would 
be  brought  together,  and  daily  and  unceasingly  intermingle, 
and  yet  the  soldiers  of  one  regiment  would  almost  all  have 
the  disease,  while  those  of  the  other  would  almost  all  escape.* 
Could  this  have  happened,  if  contagion  had  any  agency  in  its 
propagation  ? It  would  appear  much  more  rational  to  con- 
clude that  some  atmospheric  causes  existed  where  one  had 
been  previously  stationed,  and  which  was  absent  where  the 
other  had  been  located.  It  may  be  said  that  the  disease  be- 
ing mainly  confined  to  large  towns  and  dense  populations,  in- 
dicates its  spread  by  contagion.  But  the  mild  form  of  the 
epidemic  has  been  almost  as  general  in  the  country  as  in  the 
city.  This  difference  appears  perfectly  explainable  from  the 
difference  in  the  concentration  of  the  causes.  In  the  cities 
great  preparations  were  made  for  the  reception  of  the  epidem- 
ic ; old  sewers  were  often  opened,  to  the  exhalations  of  which, 
the  population  were  exposed.  If  we  have  the  general  ep- 
idemic predisposition,  and  the  concurrence  of  a cause  suffi- 
cient alone  to  produce  the  disease,  contagion  would  certainly 
be  unnecessary  to  its  production.  We  not  only  have  nox-? 


* Bombay  Report, 


Spencer  on  Asiatic  Cholera- 


81 


ious  exhalations  in  large  towns,  but  a general  concentration 
of  all  the  exciting  causes.  Napoleon  used  to  remark,  “ that 
a man  could  dodge  a single  ball,  but  could  not  dodge  twenty,” 
and  frequently  ordered  a platoon,  or  park  of  artillery,  to  fire 
on  a given  point.  The  fatality  generally  told  the  effect.  In 
cities,  we  have  the  epidemic  influence,  intemperance,  filth, 
poverty,  indigestible  meals,  changes  from  heat  to  cold,  ca- 
thartic drugs,  and  “ cholera  reports,”  producing  a sympathet- 
ic terror  of  the  population,  either  of  which  is  alone  sufficient 
to  induce  the  disease,  and  at  times  even  death.  If  so  many 
fatal  causes  are  concentrated  in  one  place,  do  we  need  the  ad- 
ventitious aid  of  contagion,  to  account  for  its  spread  or  mor- 
tality ? 


CHAPTER  IX. 

OF  THE  TREATMENT  OF  THE  FIRST  STAGE. 

In  the  treatment  of  the  early  period  of  the  epidemic,  the 
subject  presents  itself  under  two  general  heads — preventive 
and  curative.  Among  the  means  of  avoiding  the  disease,  may 
be  classed  those  under  the  control  of  each  individual,  and 
others  belonging  specially  to  the  supervision  of  the  public 
authorities. 

1>  Of  the  individual  means  of  avoiding  the  disease. — ( a ) 
Pure  air  constitutes,  at  all  times,  an  essential  ingredient  for 
the  preservation  of  individual  health,  but  during  the  preva- 
lence of  the  epidemic,  its  importance  is  greatly  enhanced, 
from  the  circumstance,  that  an  impure  atmosphere,  resulting 
from  filth,  produces  a similar  effect  upon  the  organs  of  the 
body,  as  that  induced  by  the  general  cause  of  the  epidemic. 
Every  individual  has  it,  therefore,  in  his  power,  by  a proper 
regard  to  personal  cleanliness,  to  guard  against  attacks  of  the 
disease. 

(h)  The  food  should  consist  of  such  articles  as  are  easy  of 
digestion,  and  all  irregularities  as  to  time  and  quantity  should 


83 


Spencer  on  Asiatic  Cholera. 


be  avoided.  The  functions  of  the  stomach  being  much  weak- 
ened in  almost  every  individual,  during  the  continuance  of 
the  epidemic,  it  is  important  that  the  quantity  of  food  should 
be  conformed  to  the  powers  of  the  stomach.  A person  had 
much  better  eat  too  little  than  too  much,  because  all  that  is 
not  well  digested,  does  injury,  and  often  excites  the  disease. 
The  diet,  therefore,  should  not  only  be  nourishing  but  moder- 
ate. Great  changes  of  diet,  however,  should  not  be  made, 
those  accustomed  to  high  living  being  liable  to  have  the  dis- 
ease excited  by  too  suddenly  withdrawing  the  accustomed  sti- 
mulus of  the  stomach.  Crude  food,  or  a large  meal,  is  in 
health  a very  frequent  exciting  cause  of  diarrhoea,  and  its  ef- 
fects must  be  greatly  increased  by  the  susceptibility  produced 
upon  the  intestinal  membranes  by  the  epidemic  influence.  It 
should,  therefore,  be  expected  that  profuse  serous  discharges 
would  be  the  immediate  effect  of  large  indigestible  meals,  as 
proved  by  the  history  of  the  disease,  and  hence  they  should 
be  cautiously  avoided. 

( c ) Drinks  require  to  be  equally  subjected  to  proper  regu- 
lation, otherwise  no  rules  of  diet  can  be  in  the  least  available. 
As  intemperance  in  drinking  is  one  of  the  most  common  ex- 
citants of  the  epidemic,  it  can  therefore  hardly  be  expected  that 
the  temperate  will  bear  the  use  of  ardent  spirits  with  impuni- 
ty. Notwithstanding  the  high  authority  by  which  brandy  has 
been  recommended  as  a preventive  of  the  attacks  of  this  dis- 
ease, I am  fully  satisfied,  that  ardent  spirits  are  not  only  un- 
necessary, but  injurious  to  those  previously  unaccustomed  to 
their  use.  To  those,  however,  habituated  to  its  daily  employ- 
ment, it  may  be  proper  to  say,  that  a sudden  suspension  of  the 
habit  during  the  epidemic,  might  expose  them  to  hazard,  but 
great  moderation  should  be  exercised,  since  the  slightest  excess 
is  liable  to  bring  on  the  severe  grades  of  the  malady.  Malt 
liquors,  in  moderate  quantity,  from  the  carbonic  acid  they 
contain,  afford  a grateful  stimulus  to  the  stomach,  and  aid  the 
process  of  digestion.  Port  or  Madeira  wine  may  be  advan- 
tageously employed  for  the  like  purpose,  when  the  function 
of  the  stomach  is  weakened  from  previous  disease,  or  when 


Spencer  on  Asiatic  Cholera. 


83 


great  oppression  is  produced  by  the  effects  of  the  epidemic  in- 
fluence. Under  such  circumstances,  wine  produces  a tem- 
porary aid  to  digestion,  especially  if  a meal  remains  long  un- 
changed upon  the  stomach. 

( d ) Warm,  clothing  is  important  to  guard  against  the  vicis- 
situdes of  weather,  and  all  changes  from  heat  to  cold,  should 
be  promptly  met  by  an  increase  of  this  article.  This  direc- 
tion is  exceedingly  important,  since  the  whole  history  of  the 
disease  proves  that  exposure  to  cold,  or  rain  storms,  or  sudden 
changes  from  heat  to  cold,  have  greatly  aggravated  the  attacks 
— circumstances  to  be  expected,  since  a sudden  check  of  perspi- 
ration would  produce  a rush  of  fluids  to  the  internal  parts, 
and  the  predisposed  membranes  of  the  intestines  would  invite 
disease  to  those  organs.  Flannel  next  to  the  skin,  is  indis- 
pensable to  the  health  of  those  who  are  much  subjected  to  the 
vicissitudes  of  weather  during  the  cool  seasons.  Beds  should 
be  abundantly  supplied  with  clothing,  since  the  cool  night  air 
is  exceedingly  liable  to  excite  the  epidemic.  All  unnecessa- 
ry exposures  to  currents  of  air,  or  night  or  morning  damps, 
should  be  guarded  against  or  sedulously  avoided. 

(e)  All  exertions  of  body  and  mind  require,  during  the 
prevalence  of  the  epidemic,  to  be  subjected  to  careful  regula- 
tion, avoiding  every  exertion  which  excites  or  fatigues  either. 
Fear  is  a common  exciting  cause  of  diarrhoea  in  health.  Who 
but  has  observed,  that  any  strong  emotion  of  mind,  will  often 
suspend  the  appetite  for  food,  and  that  a meal  previously  re- 
ceived, lies  like  a weight  upon  the  stomach,  producing  great 
oppression  ? A person  sitting  down  to  a meal,  on  hearing 
some  unpleasant  intelligence,  has  his  appetite  suddenly  sus- 
pended. Fear  often  produces  vomiting  and  diarrhoea  in  the 
duellist,  and  that  it  frequently  produces  a like  effect  upon  the 
soldier,  suddenly  summoned  to  an  engagement,  or  the  person 
frightened  at  the  appearance  of  a thunder-storm,  or  laboring 
under  alarm  from  any  cause,  is  a fact  of  universal  notoriety.. 
The  attacks  of  this  epidemic  have  been  most  frequent  during 
the  night.  Impressions  are  always  more  vivid  during  our 
sleeping  than  waking  hours.  During  sleep,  the  voluntary 


84 


Spencer  on  Asiatic  Cholera. 


operations  of  mind  are  suspended.  Fear  keeps  man  half 
awake;  imagination,  an  involuntary  operation  of  mind,  pre- 
sents to  the  timorous  person,  who  has  labored  under  previous 
diarrhoea,  the  belief  that  he  has  the  “ cholera .”  Dreams  are 
always  realities,  and  he  is  roused  by  the  extreme  symptoms, 
at  the  hour  of  night,  when  H the  clock  sounds  the  knell  of  his 
departed  years.”  The  connection  between  fear  and  diarrhoea, 
as  cause  and  effect,  is  established  by  universal  observation, 
and  the  effects  of  this  passion,  in  health,  entirely  simulate  the 
first  stage  of  the  epidemic,  being  characterized  by  distress  at 
the  pit  of  the  stomach,  and  a diarrhoea  almost  free  from  pain. 
If,  then,  this  passion  excites  the  same  disease  in  health,  can 
we  wonder  at  its  fatal  effects  during  the  epidemic  constitution 
of  the  atmosphere  ? One  of  the  best  preventives  must,  there- 
fore, be  a serene  and  tranquil  mind,  bent  upon  meeting,  un- 
moved, every  emergency.  The  hours  of  exercise  and  repose 
should  be  carefully  observed,  and  no  business  should  prevent 
their  methodical  regulation.  This  direction  should  not,  how- 
ever, be  supposed  to  interfere  with  the  extension  of  the  most 
full  and  ample  provisions  for  the  relief  and  comfort  of  the 
sick. 

2.  Of  the  public  means  of  preventing  the  epidemic. — The 
observation  and  experience  of  every  section  of  the  globe,  ap- 
pear abundantly  to  prove  that  the  epidemic  cannot  be  exclud- 
ed from  a country  by  quarantine  laws — a circumstance  to  be 
expected,  if  the  views  presented  of  the  nature  of  the  disease 
be  correct.  But  it  is  not  thence  intended  to  convey  the  idea 
that  quarantine  regulations  are  of  no  utility,  since  much  may 
be  done  by  the  public  authorities  to  prevent  and  mitigate  the 
sufferings  produced  by  severe  epidemics.  It  may,  therefore, 
be  proper  in  this  place  to  offer  some  suggestions,  not  only  to 
the  medical  profession,  but  to  those  who  are  the  guardians  of 
the  public  health,  in  relation  to  the  best  means  of  lessening 
the  terrors  and  fatality  of  this  disease,  should  it  continue  to 
devastate  our  country. 

(a)  Nothing  contributes  more  efficiently  to  individual  or 
public  health,  than  cleanliness , since  its  converse  engenders  s 


Spencer  on  Asiatic  Cholera. 


85 


local  or  general  contaminated  atmosphere  ; always  a frightful 
source  of  disease,  but  especially  so  of  the  present  affection, 
even  unaided  by  its  epidemic  predisposition.  Too  much  can 
not,  therefore,  be  done  by  judicious  means  to  avoid  an  impure 
atmosphere  in  a dense  population.  It  is  believed,  however, 
that  a great  error  has  obtained  in  some  places  in  the  means 
employed  for  securing  the  cleanliness  of  a town  in  preparing 
for  the  expected  visit  of  the  present  epidemic.  The  opening 
and  exposing  of  old  sewers  and  other  depositories  of  filth,  es- 
pecially during  the  hot  season,  is  a circumstance  which  has 
probably  added  to,  instead  of  dissipating,  the  contaminated 
condition  of  the  atmosphere.  Dr.  Winslow,  in  his  “ essay  on 
cholera,”  refers  to  some  interesting  cases  which  occurred  in 
1815  or  1816,  in  the  neighborhood  of  London,  at  a school 
near  Clapham.  He  remarks,  “ that  it  came  out  without  any 
suspicion  of  the  kind  having  been  awakened  before  the  circum- 
stance was  related  to  Mr.  Angus,  that  a drain  that  had  been 
choked  for  many  years,  had  been  discovered  behind  the  house 
and  partially  opened.  Directions  were  given  to  eleanse  it, 
and  during  that  operation  the  scholars  gathered  repeatedly 
about  the  opening,  from  which  issued  a most  offensive  effluvi- 
um, and  assisted  the  men  in  their  labors.”  A complaint 
simultaneously  broke  out  among  the  scholars,  who  were  near- 
ly all  affected  with  symptoms  of  more  or  less  severity,  and  so 
entirely  resembling  those  as  to  leave  no  reasonable  doubt  of 
its  being  the  same  disease — tho  epidemic.  This  circumstance 
would  strongly  indicate  the  propriety  of  cleansing  drains  and 
removing  other  sources  of  mischief  of  this  description,  in  large 
towns,  in  the  cold  season,  and  when  no  general  predisposition 
to  this  class  of  diseases  pervades  the  atmosphere. 

(h ) Great  care  should  be  exercised  by  boards  of  health,  to 
avoid  the  crowding  together  of  ill-fed,  poor,  or  intemperate 
persons,  during  the  prevalence  or  apprehended  invasion 
of  the  disease.  With  this  view,  some  efficient  measures 
might  be  properly  adopted  to  prevent  the  crowding  together 

12 


86 


Spencer  on  Asiatic  Cholera. 


of  many  emigrants  on  board  of  boats.  These  vehicles  like- 
wise should  be  subjected  to  repeated  cleansings. 

(c)  When  the  disease  breaks  out  in  a crowded,  ill-ventil- 
ated filthy  tenement,  or  in  the  vicinity  of  stagnant  waters,  no 
time  should  be  lost  in  removing  the  inmates  to  a more  airy 
location.  This  has,  in  repeated  instances,  appeared  effectu- 
ally to  check  the  extension  of  the  disease. 

( d)  F rom  the  known  effects  of  sympathy  and  fear,  in  ex- 
citing and  aggravating  this  disease,  too  many  sick  persons 
should  not  be  crowded  into  the  same  apartment. 

(e)  In  the  employment  of  nurses,  great  care  should  be  ex- 
ercised not  to  select  those  who  from  intemperate  habits,  or 
timorous  dispositions,  are  naturally  predisposed  to  attacks  of 
this  disease. 

(f)  In  country  places  it  is  frequently  a matter  of  exceeding 
difficulty  to  procure  necessary  attendants  upon  the  sick.  Un- 
der such  circumstances,  there  would  be  an  obvious  propriety  in 
having  several  persons  employed  at  the  public  expense,  ready 
at  a moment’s  warning,  to  afford  the  rites  of  humanity  to  the 
sick.  No  considerations  of  public  economy  should  interpose 
a barrier  in  a matter  of  such  vital  importance. 

(g)  “I  might  also  add,  that  considering  how  powerful  an 
exciting  cause  intemperance  appears  to  be,  whilst  it  is  at  all 
times  the  dictate  of  sound  public  policy,  to  use  every  effort  to 
stop  its  progress  and  to  control  its  influence,  it  is  especially  so 
during  the  prevalence  of  this  disease.  It  should  be  remem- 
bered, that  intemperance  not  only  increases  the  number  of 
victims  of  the  disease,  but  in  this  very  way  also  increases  the 
general  alarm,  and  thus  aggravates  not  only  the  predisposing 
but  exciting  causes.”* 

(h ) No  pains  should  be  spared  during  the  prevalence  of 
the  epidemic,  to  see  that  those  who  are  unable  to  provide  for 
themselves,  should  be  supplied  with  sufficient  food  and  cloth- 
ing. This  is  no  less  the  dictate  of  humanity  than  of  sound 
policy  ; since  those  who  eventually  contribute  for  this  pur- 

* See  44  report  on  cholera,”  made  to  Gov.  Tbroop,  by  Lewis  C.  Beck,  M.  D. 


Spencer  on  Asiatic  Cholera. 


87 


pose,  are  indirectly  benefited  by  the  lessening  of  the  gen- 
eral mortality,  which  excites  universal  panic,  always  a fruit- 
ful source  of  the  disease. 

(i)  u Cholera  preventives ” have  been  among  the  common 
exciting  causes  of  this  disease,  and  the  mischief  of  which  they 
have  been  productive  is  incalculable.  Not  to  allude  to  the 
fatal  tendency,  under  all  circumstances,  of  allowing  ignorant 
pretenders  to  the  healing  art,  to  distribute  with  entire  impuni- 
ty every  poisonous  drug,  I can  not  forbear  alluding,  on  this 
occasion,  to  the  immeasurable  mortality  resulting  from  this 
source  during  the  prevalence  of  the  present  epidemic.  The 
mischief  occasioned  by  these  pretended  preventives,  has  been 
mainly  produced  by  the  general  distribution  of  stimulants,  but 
especially  cathartic  drugs.  What ! a dose  of  physic  do  inju- 
ry ? Under  ordinary  conditions  of  the  atmosphere,  or  during 
the  prevalence  of  almost  any  other  epidemic,  a simple  dose  of 
cathartic  medicine  could  rarely  be  productive  of  injurious 
consequences.  But  such  is  the  susceptible  condition  of  the 
bowels,  during  the  prevalence  of  this  disease,  that  one  tenth 
part  of  a common  dose  has  often  produced  the  severest 
grades  of  the  complaint.  I speak  advisedly  on  this  subject, 
having  witnessed  the  fatal  effects  of  cathartics  in  several  in- 
stances, where  they  had  been  given  as  preventives.  Indeed, 
in  every  place  where  the  disease  has  prevailed,  the  public 
press  has  teemed  with  reiterated  warnings  against  people 
having  recourse  to  this  class  of  drugs,  without  the  advice  of  a 
skilful  physician.  Perhaps  no  subject  more  deserves  the  at- 
tention of  legislatures  and  boards  of  health,  than  this,  and 
should  the  epidemic  recur,  as  it  is  very  probable  it  may,  the 
interests  of  humanity  would  be  greatly  advanced  by  an  ordin- 
ance prohibiting  the  vending  of  such  medicines,  except  under 
proper  restrictions. 

(1c ) During  the  prevalence  of  all  epidemics,  fear,  and  the 
depressing  passions,  are  injurious,  but  they  are  prominently  so 
in  this,  from  their  known  tendency,  even  in  health,  to  pro- 
duce diarrhoea.  It  is,  therefore,  a matter  of  the  deepest  mo- 


89 


Spencer  on  Asiatic  Cholera . 


ixient  to  preserve  tranquility  in  the  public  mind.  During 
military  campaigns,  every  soldier  is  instructed  in  the  method 
of  arresting  bleeding  from  wounds,  and  some  military  com- 
manders have  for  this  purpose  humanely  furnished  every  sol- 
dier with  a field  tourniquet  (a  stick  and  handkerchief)  pre- 
vious to  an  engagement.  At  the  approach  of  the  epidemic, 
it  is  believed  that  boards  of  health  might  subserve  the  interests 
of  humanity  by  distributing  a few  sanatory  precautions  to 
every  inhabitant,  to  put  him  upon  his  guard,  and  inspire  him 
not  only  with  hope,  but  a confidence,  that  with  proper  care 
and  attention  he  can  escape  the  dangerous  stage  of  this 
disease.  W:lh  this  view,  in  addition  to  repeated  enquiries 
into  their  wants  and  health,  something  like  the  following  sim- 
ple rules  might  very  properly  be  put  into  the  hands  of  every 
family,  thereby  constituting  them  the  centinels  of  their  own 
life  and  health. 

First,  To  keep  their  persons,  houses  and  premises  cleanly. 

Second.  To  live  upon  light  nourishing  diet,  as  salted  meats, 
eggs,  milk,  farinaceous  vegetables,  such  as  preparations  of 
wheat,  rye,  potatoes,  rice,  oat  meal,  partaking  of  moderate 
meals. 

Third.  To  avoid  the  use  of  much  fresh  meats,  especially 
VGal,  or  hard  salted  meats,  such  as  ham. 

Fourth.  To  lay  aside  all  crude  vegetables,  such  as  cucum- 
bers, green  corn,  plums,  peaches,  &c. 

Fifth.  To  wear  warm  clothing  in  the  cold  season,  to  put 
flannel  next  the  skin,  to  avoid  sudden  exposure  to  cold  or 
damp  air,  and  during  the  night  to  take  care  that  the  bed 
clothing  be  such  as  to  prevent  the  increasing  cold  from  giving 
a sudden  check  to  perspiration. 

Sixth.  Bilious  diarrhoea,  characterized  by  yellow  stools, 
should  not  excite  apprehensions,  as  it  generally  shows  an  ex- 
emption from  the  epidemic.  If,  however,  it  becomes  profuse, 
and  the  evacuations  are  watery,  it  may  terminate  in  the  se- 
vere disease. 

Seventh.  The  symptoms  which  first  appear,  are  distress 
and  faintness  at  the  stomach , and  milky  or  watery  discharges 


Spencer  on  Asiatic  Cholera. 


89 


from  the  bowels,  often  devoid  of  smell,  and  unaccompanied 
with  pain. 

Eighth.  These  symptoms,  although  moderate,  demand  at- 
tention, being  liable  from  slight  causes,  to  run  into  the  severe 
grade  of  the  malady. 

Ninth.  All  domestic  medicines  should  in  general  be  avoid- 
ed, but  in  case  of  a sudden  severe  attack  of  diarrhoea , and  no 
physician  is  at  hand,  the  following  precautions  maybe  taken. 

Tenth.  Provide  laudanum  of  common  strength,  and  to  an 
adult  give  20  or  30  drops  every  half  hour,  till  the  complaint 
abates,  or  until  three  or  four  doses  are  taken,  at  the  same 
time  covering  warm  in  bed,  and  taking  warm  chicken,  crust 
or  corn  tea.  It  should  be,  however,  borne  in  mind,  that 
laudanum  is  generally  injurious  in  this  disease,  and  that  it 
should  not  be  used  unless  its  effects  are  promptly  counteracted 
by  the  skilful  physician. 

Eleventh.  If  vomiting  supervene,  it  should  be  promoted  by 
warm  drinks,  as  chicken  tea ; and  laudanum  should  not  be 
taken  unless  the  purging  becomes  profuse  and  watery,  when 
it  may  be  given  as  directed  above. 

Twelfth.  Vomiting  should  not  be  considered  a necessary  or 
dangerous  symptom  of  the  epidemic,  but  that  large  watery 
stools , although  no  pain  be  present,  are  attended  with  immi- 
nent hazard,  and  call  for  prompt  attention. 

Thirteenth.  Cathartic  medicines  produce  an  artificial, 
equally  hazardous  with  natural,  diarrhoea  ; even  in  small 
doses  they  are  liable  to  excite  the  epidemic,  and  unless  advis- 
ed by  a physician,  should  be  shunned  as  the  hyena  or  the  rat- 
tle snake. 

Fourteenth.  The  disease  is  in  general  perfectly  cureable  in 
its  early  stage,  and  danger  results  only  from  a disregard  of 
proper  precaution.  However  delicate  the  subject,  or  painful 
the  reflections  to  which  it  leads,  duty  impels  me  to  invite  pub- 
lic attention  to  the  impropriety  of  the  practice  of  suddenly 
burying  those  who  fall  victims  to  this  disease.  In  prosecuting 
my  enquiries  into  the  nature  of  this  disease,  I came  to  the  ir- 
resistible conclusion,  that  death  in  many  instances,  was  pro- 


90 


Spencer  on  Asiatic  Cholera. 


duced  precisely  as  from  bleeding ; that  the  solid  parts  of  the 
body  remain  entirely  uninjured,  and  that  a patient  might  re- 
main a considerable  time  in  a swooning  condition,  apparently 
dead,  and  yet  subsequently  become  resuscitated.  From  the 
concurrent  testimony  of  some  of  the  most  respectable  mem- 
bers of  the  medical  profession,  it  appears  that  several  cases 
have  occurred  in  which  patients  have  for  some  hours  been 
apparently  dead,  and  yet  have  subsequently  recovered.  From 
the  sudden  manner  in  which  persons  have  been  hurried  to  the 
grave,  during  the  terrors  awakened  by  the  ravages  of  this  des- 
troyer, the  opinion  cannot  be  resisted,  that  many  have  been 
buried  alive.  Humanity  shudders  at  the  thought.  This 
part  of  my  subject  I feel  unwilling  to  close,  without  imploring 
not  only  the  medical  profession,  and  the  functionaries  wTho 
are  the  guardians  of  the  public  health,  but  every  philanthropic 
individual,  to  aid  in  turning  the  broad  current  of  public  senti- 
ment against  the  marked  inhumanity  of  such  sudden  inter- 
ments. 

3.  Of  the  remedies  for  the  first  stage. — In  no  disease  can 
our  remedies  be  employed  with  much  prospect  of  success,  if 
delayed  till  the  last  struggles  of  life.  This  remark  emphat- 
ically applies  to  the  present  epidemic,  from  its  sudden  termin- 
ation in  collapse,  if  its  insidious  dawnings  are  overlooked,  and 
we  wait  for  vomiting  and  spasms  to  point  us  to  the  invasions 
of  the  foe.  In  the  first  stage,  even  the  unaided  efforts  of  nature 
are  sufficient,  many  times,  to  perform  the  cure,  and  such  is 
the  certainty  of  remedies  in  this  stage,  that  by  due  care,  on 
the  part  of  physicians  and  the  community,  the  disease  may 
generally  be  controlled.  The  indications  of  treatment  are — 
1st.  To  allay  the  susceptibility  of  the  intestines  and  stop 
the  tendency  of  the  cutaneous  and  urinous  fluids  towards 
them,  by  acting  upon  the  skin  and  kidneys. 

2d.  To  restore  the  weakened  functions  of  the  stomach  and 
liver.  When  the  patient  sutlers  from  slight  oppression  at  the 
stomach,  accompanied  by  a furred  slimy  tongue,  relief  may 
be  obtained  by  a blue  pill,  or  a few  grains  of  calomel  at  night, 
followed  in  the  morning  by  a moderate  dose  of  rhubarb 


SPENCER  on  Asiatic  Cholera. 


91 


and  cream  of  tartar,  or  magnesia  and  rhubarb,  and  subse- 
quently by  some  bitter  drink.  If  slight  diarrhoea  be  present^ 
the  mercurial  should  be  combined  with  sulphate  of  morphia 
or  Dover’s  powder,  and  with  the  pediluvium  and  warm  drinks 
to  promote  perspiration.  To  these  may  be  added  mucilages 
and  mild  diuretics,  or  the  spirits  of  nitre,  to  allay  the  irritable 
condition  of  the  bowels,  and  determine  to  the  kidneys.  Sub- 
sequent exposure  to  cold  should  be  cautiously  avoided,  and 
the  patient  should  not  be  too  suddenly  allowed  to  rise  from 
his  bed,  and  thus  expose  himself  to  the  return  of  the  disease. 
A dose  of  castor  oil  and  laudanum  at  night,  followed  by  warm 
diluents,  will  frequently  afford  relief.  The  distress  of  stom- 
ach is  sometimes  accompanied  with  costiveness,  which  may 
be  obviated  by  small  doses  of  soap  pills,  or  by  castor  oil,  dur- 
ing every  stage  of  the  disease. 

If  opening  medicines  are  employed,  they  should  be  of  the 
mildest  character.  Active  cathartics  always  expose  the  pa- 
tient to  the  hazard  of  the  same  disease,  and  should  be  care- 
fully shunned.  Notwithstanding  many  patients  might  get 
well  under  their  administration,  yet  it  would  seem  equally  as 
rational  to  expose  an  inflamed  limb  to  repeated  motion,  to 
afford  relief,  as  to  administer  a remedy  whose  specific  action 
is  to  augment  the  general  predisposition  by  exciting  intestinal 
exhalation,  which  constitutes  the  essential  nature  of  this  ep- 
idemic. So  fully  am  I satisfied  of  the  propriety  of  this  posi- 
tion from  repeated  observation,  that  I should  be  wanting  in 
duty  if  I omitted  to  express  my  entire  conviction,  that  ca- 
thartic drugs  should  be  excluded  from  our  remedial  means. 
In  the  mild  cases  of  recent  origin,  the  remedies  above  de- 
tailed may  be  sufficient  to  secure  an  exemption  from  the  se- 
vere grades  of  the  disease,  but  when  the  diarrhoea  has  been 
protracted,  or  is  becoming  severe,  there  is  no  security  short 
of  a combination  of  emetic  and  sudorific  remedies.  It  is  not 
wished  to  underrate  too  much  the  use  of  opiates,  astringents, 
or  the  other  remedies  often  employed  for  this  purpose,  but  the 
patient  is  exceedingly  apt  to  relapse,  when  the  disease  is 
checked  in  this  manner,  especially  if  it  be  followed  by  cathar- 


9 2 


Spencer  on  Asiatic  Cholera. 


tic  drugs.  Opiates  tend  to  interrupt  the  urinary  secretion, 
which,  even  at  this  early  period,  is  often  much  lessened. 
Emetics  are  at  all  times  among  our  most  efficient  means  of 
rousing  the  weakened  functions  of  both  the  stomach  and  liv- 
er, which  constitutes  an  important  part  of  the  indications  in 
this  stage  of  the  disease.  Not  only  so,  but  they  are  among  our 
most  prompt  means  of  acting  upon  the  exhalent  tissue  of  the 
surface.  When  the  diarrhma  is  moderate,  ipecac  or  eupato- 
rium,  or  both  combined,  may  properly  be  employed,  confining 
the  patient  in  bed,  and  administering  warm  drinks  to  promote 
perspiration.  If  the  diarrhoea  be  severe,  vomiting  and  sweat- 
ing should  both  be  free,  and  promptly  procured.  This  may 
be  produced  by  a combination  of  emetic  tartar  and  ipecac, 
provided  a dose  sufficient  to  act  promptly,  is  used.  Nothing 
is  more  improper  than  half  doses  of  emetics,  especially  if  tar- 
tarised  antimony  is  employed,  from  its  known  tendency,  in 
small  and  repeated  doses,  to  run  off  by  the  bowels,  and  in  this 
disease  thus  augmenting  the  very  discharge  it  is  intended  to  re- 
lieve. This  occasional  effect  of  emetic  tartar  renders  it  some- 
what objectionable,  and  it  is  believed  that  the  sulphate  of 
zinc  and  ipecac,  as  recommended  by  Dr.  M‘Naughton,  may 
be  safely  and  advantageously  substituted  in  most  cases,  where 
the  diarrhoea  has  been  of  considerable  standing.  Sulphate 
of  zinc  5 grs.,  combined  with  20  or  30  grs.  of  ipecac,  may 
be  given  in  a wine  glass  of  warm  water,  and  if  not  vomited 
in  8 or  10  minutes  may  be  repeated,  or  20  grs.  of  ipecac  alone 
may  be  repeated  every  few  minutes  till  full  vomiting  is  pro- 
duced. The  eupatorium,  from  its  emetic,  diaphoretic  and 
tonic  properties,  is  admirably  adapted  to  the  cure  of  this  dis- 
ease, and  a strong  infusion  of  this  article  or  chamomile  may- 
be very  advantageously  administered  to  promote  the  opera- 
tion of  the  emetics. 

After  the  operation  of  the  emetic,  the  tone  of  the  stomach 
may  be  restored  by  the  use  of  some  vegetable  bitter,  as  quas- 
sia, columbo  or  gentian,  with  the  occasional  use  of  wine. 
The  above  remedies,  with  the  preventive  cautions  detailed, 
constitute  the  sum  of  the  means  necessary  to  cure  this  stage 
of  the  epidemic,  and  their  efficient  application  may  in  a great 
measure  disarm  it  of  its  terror' 


Spencer  on  Asiatic  Cholera . 


93 


CHAPTER  X. 

OF  THE  TREATMENT  OF  THE  SECOND  STAGE. 

The  leading  indications  which  follow  from  the  pathological 
view  taken  of  this  stage  of  the  disease,  are  obviously, 

1.  To  arrest  the  intestinal  discharges; 

2.  To  make  a transfer  or  metastasis  of  the  serous  discharg- 
es  from  the  exhalents  of  the  bowels  to  those  of  the  external 
surface. 

3.  To  restore  the  lost  balance  and  healthy  performance  of 
the  various  excretory  and  secretory  functions. 

4.  To  support  the  powers  of  the  system,  and  combat  in- 
cidental symptoms. 

The  first  three  indications  may  in  a large  proportion  of 
cases  be  simultaneously  fulfilled  by  a combination  of  active 
emetics  and  sudorifics.  To  these  the  disease  yields  with 
great  promptitude,  provided  a dose  sufficient  to  act  efficient- 
ly is  employed.  Nothing  can,  however,  be  more  improper 
than  the  exhibition  of  half  doses  of  emetics  in  this  stage,  since 
every  thing  depends  upon  making  a prompt  and  decided  im- 
pression upon  the  disease.  If  the  operation  of  emetics  is 
prompt  and  active,  all  the  energies  of  the  system  seem  to  be 
aroused — the  face  resumes  its  wonted  flush*  a free  warm  per- 
spiration starts  from  every  pore,  and  the  patient  is  compa- 
ratively safe.  (Case  2.)  On  the  contrary,  ineffectual  retch- 
ings at  considerable  intervals,  attended  with  a kind  of  passive 
vomiting,  whether  produced  by  emetic  drugs,  or  coming  on 
as  symptoms  of  the  disease,  always  tend  to  prostrate  the  pow- 
ers of  the  patient.  In  the  choice  of  emetics,  therefore,  it 
should  be  an  object  to  employ  those  which  act  promptly,  and 
the  stage  of  the  malady  should  always  influence  our  selec- 
tion. In  the  early  part  of  this  stage,  I have  employed  a com- 
bination of  emetic  tartar  and  ipecac,  and  it  has  rarely  disap- 
pointed my  expectations.  (Case  5.)  In  the  more  advanced 
period,  or  where  the  preceding  diarrhoea  has  been  of  long 
standing,  the  emetic  tartar  should  be  exchanged  for  the  sul- 
phate of  zinc,  as  recommended  in  the  first  stage. 

13 


94 


Spencer  on  Asiatic  Cholera. 


This,  from  its  astringent  properties,  is  by  no  means  so  li- 
able to  run  off  by  the  bowels  as  the  tartarised  antimony, 
which  must  always  be  injurious  when  it  acts  in  this  manner. 
The  white  vitriol,  from  its  rapid  action  upon  the  stomach,  in 
many  instances,  suddenly  suspends  the  large  serous  discharg- 
es, as  if  by  a grasp  of  the  whole  abdominal  viscera.  (Case  9.) 
When  a large  indigestible  meal  has  been  the  exciting  cause 
of  the  disease,  it  is  at  all  times  an  object,  while  it  remains,  to 
dislodge  it  from  the  stomach,  but  this  organ,  as  well  as  the 
bowels,  soon  become  washed  out  by  the  serous  fluids.  Un- 
der such  circumstances  it  should  be,  therefore,  borne  in  mind, 
that  the  operation  of  the  emetic  is  not  so  much  to  dislodge 
morbid  matter,  as  to  give  a centrifugal  direction  to  the  fluids, 
for  the  purpose  of  equalizing  their  circulation,  and  especially 
to  act  upon  the  skin.  Their  operation,  should,  therefore,  be 
promoted  by  copious  drafts  of  eupatorium  tea,  or  chamomile 
tea,  and  the  vomiting  should  be  continued  till  the  patient 
sweats  profusely.  It  is  likewise,  at  times,  necessary  to  aid 
their  operation  by  irritation  of  the  fauces.  During  the  vom- 
iting., the  patient's  surface  should  by  no  means  be  exposed  to 
the  air,  as  this  would  obviously  check  the  perspiration.  The 
patient  should,  therefore,  be  well  covered  with  bed  clothes, 
allowing  no  part,  save  the  face,  to  be  exposed.  In  some  in- 
stances vomiting  and  purging  were  both  suddenly  arrested, 
on  giving  an  emetic,  and  considerable  difficulty  was  after- 
wards experienced  in  procuring  full  emesis.  This  rarely  hap- 
pened unless  the  disease  had  advanced  so  far  that  the  vomit- 
ing and  purging  seemed  rather  passive  than  active,  and  the 
constitutional  energies  had  become  much  prostrated.  Indeed, 
such  is  at  times  the  condition  of  the  stomach,  that  after  the 
exhibition  of  the  emetic,  it  seems  almost  to  defy  our  efforts. 
Believing  this  difficulty  resulted  from  debility  of  this  organ, 
diffusible  stimulants  have  been  given  under  such  circumstan- 
ces, and  promptly  brought  on  vomiting.  Wine,  asther,  car- 
bonate of  ammonia  or  camphor  have  been  preferred,  accord- 
ing to  the  age  or  habits  of  the  patient.  In  old  people,  a glass 
of  port  wine  repeated  every  few  minutes  has  produced  the 


Spenceh  on  Asiatic  Cholera . 


95 


best  effects,  while  in  younger  persons  or  children,  the  more 
diffusible  stimulants  should  be  preferred.  (Cases  1 and  7.) 
If  stimulants  are  used  under  such  circumstances,  and  free 
sweating  is  induced,  little  apprehension  needs  be  entertained 
of  exciting  the  consecutive  fever.  After  the  vomiting  has 
been  continued  until  free  diaphoresis  is  produced,  the  quantity 
of  diluents  may  be  lessened,  and  a few  drops  of  camphorated 
spirits,  mingled  with  a wine  glass  full  of  hot  sweetened  wa- 
ter may  be  administered  every  20  or  30  minutes  for  three  or 
four  hours  to  promote  the  sweating.  After  free  vomiting  the 
camphor  is  exceedingly  grateful  to  the  stomach,  which  is  often 
tranquilized  by  the  first  dose.  If  nausea  continues,  a weak 
solution  of  carb.  of  soda,  or  of  gum  arabic,  or  an  effervescing 
draught  may  be  employed.  In  the  early  part  of  this  stage,  the 
sweating  should  be  copious  ; but  if  the  stage  of  collapse  ap- 
proaches before  the  emetic  is  administered,  it  would  be  ob- 
viously as  injurious  too  much  to  unload  the  blood  vessels  by 
the  skin  as  bowels.  In  this  condition  of  the  system,  the 
sweating  regimen  should  be  gradually  withdrawn  as  soon  as 
an  obvious  check  is  given  to  the  intestinal  discharges,  care- 
fully avoiding,  however,  for  some  hours,  the  slightest  expo- 
sure to  cold,  which  will  reproduce  the  disease.  After  the 
continuance  of  the  camphor  and  hot  water  for  some  three  or 
four  hours,  the  patient’s  surface  should  be  wiped  with  hot 
chalk,  and  flannel,  under  the  bed  clothes,  and  these  should 
be  carefully  lightened.  The  patient  may  then  take  for  ten 
or  twelve  hours  the  camphor  and  hot  water,  and  a half  tea 
spoonful  of  spirits  of  nitre  in  water,  every  two  hours,  and  at 
the  same  time  continue  the  mucilaginous  and  alkaline  drinks. 

In  a large  proportion  of  cases  the  above  detailed  remedies 
have  been  found  to  give  an  effectual  check  to  the  disease, 
the  secretion  of  urine  soon  returning,  and  evacuations  from 
the  bowels  tinged  with  bile,  would  announce  a return  of  the 
healthy  functions,  both  of  the  liver  and  intestines.  In  a few 
instances,  after  the  patient  had  vomited  actively  for  some  time, 
bile  would  be  mixed  with  the  evacuations  from  the  stomach. 


90 


Spencer  on  Asiatic  Cholera. 


(Cases  3 and  4.)  One  great  advantage  from  this  treatment, 
is  the  almost  certain  exemption  from  consecutive  fever. 
This  is  so  uniformly  the  case,  that  I am  induced  to  believe, 
that  a vast  proportion  of  the  fevers  which  have  followed  this 
.epidemic,  have  been  the  effect  of  the  opiates,  astringents  and 
stimulants,  which  have  been  so  freely  administered  by  many 
physicians  for  its  cure.  So  fully  am  I satisfied  of  this  from 
repeated  observation,  that  although  I shall  recommend  them 
under  certain  circumstances,  yet  I wish  to  have  it  fully  un- 
derstood, that  they  should  be  regarded  as  among  our  resources, 
rather  than  remedies.  Notwithstanding  the  great  confidence 
reposed  in  the  remedies  above  detailed,  we  shall  not  be  fortun- 
ate in  all  cases,  and  constitutional  peculiarities,  or  some  un- 
expected circumstances  may  prevent  our  exhibiting  emetics, 
or  procuring  free  emesis  and  diaphoresis,  or  the  intestinal 
discharges  may  still  continue  to  threaten  the  destruction  of 
the  patient.  An  expedient  for  checking  these,  but  which  I 
have  not  employed,  was  put  in  practice  by  my  friend  and 
former  pupil,  Dr.  Benjamin  Palmer  of  Smithfield.  It  was 
the  application  of  ligatures  to  the  extremities.  These  at 
times  promptly  stopped  the  discharges.  The  analogy  of  this 
epidemic  to  hemorrhage,  in  which  this  expedient  has  been 
found  useful,  would  indicate  the  propriety  of  this  remedy. 
When  the  serous  discharges  are  profuse,  might  not  the  dash- 
ing of  cold  water  upon  the  abdomen  be  useful  ? When  our 
other  resources  fail,  a choice  of  dangers  is  presented,  the 
hazard  of  the  sudden  and  terrible  collapse,  from  the  profuse 
evacuations,  or  of  consecutive  fever,  from  the  employment  of 
opiates  or  astringents.  I think  the  latter  the  lesser  hazard, 
if  our  remedies  are  skilfully  applied.  A full  dose  of  laud- 
anum, combined  with  spirits  of  nitre,  will  at  times  tranquil- 
ize  the  stomach  and  bowels.  Under  such  circumstances, 
pills  of  opium  ^ gr.  and  sugar  of  lead  2 grs.,  may  also  be 
given  every  twenty  or  thirty  minutes.  An  enema,  of  starch 
half  a gill,  and  from  20  drops  to  a tea  spoonful  of  laudanum, 
may  be  at  once  administered.  Should  this  not  stay  the  bow- 


Spencer  on  Asiatic  Cholera. 


97 


els,  a solution  of  twenty  grains  of  saccharum  saturni,  may  be 
mixed  with  the  starch  and  laudanum,  and  thrown  up  the 
bowels.  (Cases  8 and  10.)  Should  the  injections  be  sud- 
denly discharged,  pressing  firmly  with  a cloth  upon  the  rec- 
tum, or  introducing  a plug  of  beeswax,  or  a piece  of  oiled 
cloth,  may  be  useful  in  retaining  them.  Some  medical  prac- 
titioners give  the  preference  to  combinations  of  opium  | or  A 
gr.,  with  a grain  or  two  of  calomel,  under  these  circumstan- 
ces. This  combination  should  undoubtedly  be  preferred, 
when  sufficient  promptly  to  stay  the  disease,  being  less  lia- 
ble to  produce  fever ; but  from  a careful  trial  of  both  combi- 
nations, the  lead  and  opium  have  been  found  more  prompt  in 
arresting  the  discharges,  than  the  opium  and  calomel.  But 
when  the  disease  is  stayed  by  any  of  these  means,  it  should 
be  borne  in  mind,  that  we  have  only  obtained  a truce,  and 
that  we  have  now  to  guard  against  a commotion  of  the  blood 
vessels.  The  brain  is  the  organ  most  liable  to  suffer,  when  the 
disease  is  thus  checked,  and  fever  is  to  be  guarded  against  by 
promptly  acting  upon  the  skin  and  urinary  organs,  and  excit- 
ing the  healthy  functions  of  the  liver  and  intestines.  With  a 
view  to  the  attainment  of  these  objects,  a powder  of  calomel, 
gr.  3 to  1,  ipecac,  gr.  §,  pulv.  camphor,  grs.  3,  cream  tartar, 
grs.  5,  may  be  administered  every  two  or  three  hours,  alternat- 
ing with  half  or  a tea  spoonful  of  spirits  of  nitre,  in  water. 
Warm  diluents,  as  barley  water,  gum  arabic  water,  crust  or 
balm  teas,  or  an  occasional  glass  of  hot  wTater,  combined  with 
a few  drops  of  camphorated  spirits,  as  before  directed,  maybe 
employed  to  determine  to  the  surface.  If  these  means  should 
not  succeed,  and  a hot  skin  and  coma  supervene,  recourse 
should  be  promptly  had  to  the  remedies  recommended  under 
the  head  of  consecutive  fever.  After  the  continuance  of  the 
above  remedies  for  some  twelve  or  twenty-four  hours,  if  the 
healthy  motions  of  the  bowels  are  not  restored,  some  mild 
laxatives  as  calomel  and  rhubarb,  or  rhei  and  magnesia,  cal- 
omel and  castor  oil,  or  the  oil  alone,  should  be  administered. 
It  sometimes  happens  that  great  irritability  of  the  stomach 
(Continues  after  the  intestinal  evacuations  cease,  rendering  it 


98 


Spencer  on  Asiatic  Cholera. 


difficult  to  administer  any  remedies.  When  there  is  tender- 
ness of  the  epigastrium,  scarifying  and  cupping  or  leeches  to 
that  region  are  indicated.  The  mustard  cataplasm,  or  what 
is  often  better,  a large  blister,  should  be  applied  over  the  stom- 
ach. An  effervescing  mixture,  a little  essence  of  pepper- 
mint, or  cinnamon,  crust  or  corn  tea,  or  weak  lemonade,  or  a 
piece  of  ice,  will  often  allay  this  symptom.  When  other  re- 
sources fail,  a negative  remedy  will  be  found  very  effectual, 
giving  the  stomach  nothing  to  do.  (Case  6.)  Restricting 
the  patient  to  a tea  spoonful  of  some  mild  drink,  every  half 
hour,  will  often  succeed,  when  all  medicines  fail  to  quiet 
this  organ.  If  spasms  of  the  respiratory  muscles  supervene, 
producing  convulsive  breathing,  or  if  spasms  of  the  limbs 
become  so  severe  as  greatly  to  harrass  or  exhaust  the  patient, 
the  extract  or  tincture  of  cicuta  or  hyosciamus,  as  employed 
by  the  Russian  physicians,  is  indicated,  and  is  less  liable  than 
opium  to  check  urinary  secretion.  Of  the  utility  of  blood 
letting,  I cannot  speak  from  experience,  although  an  abund- 
ance of  respectable  testimony  may  be  found  in  its  favor,  es- 
pecially among  the  writers  of  the  eastern  continent.  In  this 
country,  though  it  has  some  highly  respectable  advocates,  this 
remedy  does  not  seem  to  have  been  very  extensively  employed 
or  approved  by  physicians,  notwithstanding  the  general  prepos- 
session in  its  favor  in  the  treatment  of  many  other  diseases. 

If  the  pathological  views  of  the  disease  presented  be  cor- 
rect, bleeding  may  find  an  appropriate  place  among  our  re- 
mediate means,  but  its  indiscriminate  use  must  be  exceeding- 
ly hazardous.  The  operation  of  this  remedy  in  the  epidem- 
ic, must  be  very  similar  to  its  action  in  hemorrhage,  and  if 
employed  before  the  action  of  the  heart  and  arteries  is  pros- 
trated by  the  severe  discharges,  I can  discover  no  good 
reason  why  it  is  not  equally  safe  to  unload  the  blood  vessels 
by  the  lancet,  as  to  have  them  thus  rapidly  emptied  by  a con- 
tinuance of  the  large  serous  evacuations.  It  is  thought  that 
by  bleeding  the  patient  from  a large  orifice,  until  faintness  is 
induced,  the  discharges  may  be  thus  stayed,  and  by  directing 
our  remedies  to  the  restoration  of  the  various  secretions,  the 
patient  may  be  cured. 


Spencer  on  Asiatic  Cholera. 


99 


Some  medical  practitioners  have  very  successfully  treated 
the  disease  in  this  manner,  but  it  must  be  obvious  that  the 
remedy  is  applicable  only  to  the  early  part  of  this  stage,  when 
the  pulse  remains  vigorous  ; a period  which  often  passes  be- 
fore professional  aid  is  called.  If  the  pulse  has,  however, 
failed,  and  the  system  is  rapidly  approaching  the  collapse,  or 
this  actually  exists,  no  good  reason  can  be  discovered  for  using 
blood  letting  in  this  disease,  any  more  than  in  any  other  mala- 
dy, when  the  vital  energies  have  been  prostrated  by  direct  de- 
pletion. If  we  found  a man  nearly  or  quite  pulseless,  from 
natural  hemorrhage,  or  from  the  division  of  an  artery,  we 
should  hardly  be  considered  rational,  if  we  undertook  to  bleed 
him  to  rouse  the  system.  Now,  it  is  thought  equally  proper 
in  this  case,  as  in  the  collapse  of  the  epidemic,  when,  as  fre- 
quently happens  in  rather  slow  cases,  the  patient  has  already 
lost  a quantity  of  fluids,  equal  in  volume  to  the  estimated 
amount  of  blood  ordinarily  circulating  in  the  heart  and  blood 
vessels.  Those  cases  which  occasionally  occur  in  this  epi- 
demic, and  which  often  happen  at  the  onset  of  febrile  diseases, 
in  which  extreme  coldness  results,  from  an  oppression  of  the 
sanguiferous  system,  resulting  from  a congestion  of  the  fluids 
in  the  internal  organs,  unattended  with  evacuations,  are  often 
benefited  by  bleeding.  But  this  collapse  should  be  carefully 
distinguished  from  that  resulting  from  large  evacuations,  the 
principles  of  treatment  being  widely  different. 

On  the  use  of  cathartic  medicines,  the  conviction  can  not 
properly  be  withheld,  that  these  have  been  too  extensively  and 
indiscriminately  employed  in  the  treatment  of  this  and  the  col- 
lapse stage.  Calomel  has  been  frequently  prescribed  with  a 
view  to  its  specific  action  upon  the  liver.  This  organ  being 
secondarily  drawn  into  the  disease,  and  the  serous  discharges, 
while  they  continue,  having  a direct  tendency  to  cut  off  the 
supply  of  fluids  to  the  liver,  and  to  wash  out  whatever 
might  be  carried  into  the  intestines,  but  little  expectation  can 
be  indulged,  that  sufficient  can  be  absorbed  in  this  stage  to  in- 
fluence the  biliary  secretion.  Given  in  minute  doses,  how- 
ever, it  sometimes  acts  beneficially  in  allaying  irritability  of 


100‘ 


Spekcer  on  Asiatic  Cholera. 


the  stomach,  and  exciting  a healthy,  peristaltic  motion  of  the 
bowels.  Although  calomel  appears  to  act  principally  upon 
the  mucous  tissue  of  the  bowels,  and  is  on  that  account  less 
objectionable  than  most  cathartic  drugs,  which  act  upon  the 
exhalents,  yet  notwithstanding  the  high  authority  in  favor  of 
large  doses  of  this  article,  it  can  hardly  be  conceived  that  any 
of  this  class  of  medicines  can  he  used  to  any  extent  without 
adding  a new  exciting  cause  to  those  powerful  intestinal  dis- 
charges. That  many  patients  might  get  well,  when  it  is 
used,  is  not  denied  ; but  it  does  not  hence  follow  that  they 
recover  in  consequence  of  the  employment  of  such  remedies. 
Of  the  modus  operandi  of  emetics  in  this  disease,  little  need 
be  said  in  this  place,  after  the  exposition  of  the  pathology  of 
natural  vomiting,  in  the  remarks  upon  the  nature  of  the  se- 
cond stage.  Although  strenuously  recommended  by  Dr. 
Yates  and  others,  such  were  the  prejudices  I had  imbibed 
against  the  employment  of  emetics  in  this  disease,  that  I did 
not  venture  upon  their  use,  until  I had,  in  the  midst  of  the 
epidemic,  completed  an  analytical  examination  of  all  the  symp- 
toms of  the  disease,  and  come  to  the  conclusion  that  vomiting, 
should  be  regarded  as  a salutary  effort  of  the  system.  They 
were  then  prescribed  with  the  fullest  confidence  of  success, 
and  in  no  instance,  where  vigorous  vomiting  and  free  diapho- 
resis were  induced,  was  there  a failure  of  promptly  arresting 
the  disease,  and  an  exemption  from  consecutive  fever  was 
uniform.  The  same  result  followed  the  like  treatment,  un- 
der the  administration  of  several  professional  friends,  who 
have  obligingly  furnished  me  statements  on  this  subject.  For 
the  suggestion  of  the  idea  of  confining  the  patient  to  bed,  and 
entirely  excluding  the  external  air  from  the  surface,  I was  in- 
debted to  a communication  from  Dr.  William  Taylor  of  Man- 
lius, previously  to  either  of  us  having  witnessed  the  disease. 
By  adopting  this  suggestion,  I had  only  to  aid  the  use  of  eme- 
tics and  sudorifics  to  make  a prompt  impression  upon  the  skin. 
It  is  believed  that  this  method  of  combining  these  remediate 
agents,  may  be  advantageously  extended  to  many  other  dis- 
eases. Dr.  Charles  T.  Jackson,  in  his  observations  on  chole- 


Spencer  on  Asiatic  Cholera. 


101 


fa  in  Vienna,*  when  speaking  of  the  utility  of  emetics,  re- 
marks, that  “ at  length  one  of  the  physicians  of  the  military 
hospital,  reflecting  on  his  practice  in  the  plague,  resolved  to 
try  the  means  he  had  often  found  successful  in  that  disease,  in 
cholera;  This  treatment  consisted  in  the  administration  of 
emetic  doses  of  ipecacuanha  in  the  beginning  of  the  cold 
stage.  This  medicine  was  given  in  doses  of  ten  grains  every 
ten  minutes,  until  vomiting  was  produced- — warm  water  and 
irritation  of  the  fauces  were  also  used  to  bring  on  this  artifi- 
cial vomiting  as  soon  as  possible. 

The  effects  of  this  apparently  paradoxical  treatment  were 
surprising,  and  its  success  exceeded  even  the  most  sanguine 
anticipations  of  the  physicians  who  first  thought  of  this  remedy. 

Eighteen  individuals  in  the  cold  and  blue  stage  of  cholera, 
were  treated  by  the  means  above  noticed  ; two  died  in  the 
cold  stage,  and  two  or  three  sunk  in  the  typhoid  stage.  The 
success  of  this  experiment  drew  the  attention  of  all  the  phy- 
sicians of  Vienna  to  the  use  of  ipecacuanha,  and  the  mortali- 
ty of  cholera  began  rapidly  to  diminish.  The  changes  effect- 
ed by  this  treatment  are  as  follows  : The  first  effects  of  arti- 
ficial vomiting  were  marked  by  a determination  of  blood  to 
the  surface.  After  a short  time,  the  patient  sank,  as  if  ex- 
hausted by  his  efforts  to  vomit  The  complexion  of  the  skin 
now  changed,  the  fuliginous  tint  of  the  face  gave  way  to  a 
feverish  flush — the  sunken  appearance  of  the  eyes,  and  the 
black  rim  about  them,  gradually  disappeared.  The  whole 
surface  became  excited,  as  in  inflammatory  diseases,  and  was 
burning  hot.  The  patient  now  frequently  complained  of 
pains  in  the  stomach  and  bowels,  and  there  was  often  pain, 
augmented  by  pressure  at  the  epigastrium.  The  feverish  heat 
soon  gave  way  to  a copious  perspiration.  The  secretion  of 
urine  took  place,  and  usually  in  abundance.  This  was  re- 
garded as  critical,  and  certainly  was  one  of  the  most  favora- 
ble symptoms.  We  could  not  help  expressing  our  astonish- 
ment at  the  results  we  had  seen  by  this  mode  of  treatment. 
The  sudden  changes  effected  by  the  ipecacuanha  were  indeed 

* Medieal  Magazine,  Boston,  Oct.  1832. 

14 


m 


Spencer  on  Asiatic  Cholera. 


remarkable.  The  patients  were  affected  so  suddenly  by  it, 
that  a it  seemed  to  he  a sort  of  enchantment .” 

This  statement  of  the  utility  of  emetics  at  Vienna,  fully 
corresponds  with  the  result  of  their  employment  under  my 
observation.  Emetics  of  ipecacuanha,  were  likewise  given 
with  much  benefit,  in  some  of  the  French  hospitals,  and  even 
Hippocrates  used  emetics  in  diarrhoea  serosa,  with  a view  to 
act  upon  the  exhalents  of  the  skin.  The  analogy  of  this  dis- 
ease to  hemorrhage,  the  discharges  in  both  coming  from  the 
same  vessels,  would  lead  to  the  belief  that  emetics  might  be 
equally  serviceable  in  both  diseases.  Professor  Chapman,  of 
the  University  of  Pennsylvania,  and  other  writers  of  great 
respectability,  recommend  the  employment  of  emetics  in  bleed- 
ings from  the  stomach  and  bowels,  and  speak  of  their  great 
utility  under  the  most  desperate  circumstances.  It  is  a mat- 
ter of  general  observation  among  the  medical  profession,  that  if 
the  patient,  in  the  early  part  of  the  epidemic,  could  have  free 
diaphoresis  induced,  he  might  be  considered  secure.  If  even 
that  part  of  the  pathological  views  in  relation  to  the  mechanical 
operation  of  vomiting,  in  arresting  the  serous  discharges, 
should  be  rejected,  the  universal  effect  of  emetics  in  their  ac- 
tion upon  the  cutaneous  exhalents,  would  point  to  their  use  as 
proper  means  of  diverting  the  current  of  fluids  from  the  bow- 
els. Have  we  any  other  remedies  by  which  we  can  start  the 
sweat  from  every  pore  with  like  promptitude  or  certainty  ? 
If  the  disease  is  checked  in  this  stage,  and  the  healthy  func- 
tions of  all  the  various  organs  re-established,  the  same  means 
for  restoring  the  strength  of  the  patient  are  indicated,  as  re- 
commended under  the  treatment  of  the  first  stage. 

CHAPTER  XI. 

OF  THE  TREATMENT  OF  THE  COLLAPSE. 

This  stage  of  the  disease  has,  bv  many,  been  emphatically 
believed  to  constitute  u cholera ,”  and  regarded  in  this  light. 


Spencer  on  Asiatic  Cholera. 


103 


it  may  be  considered  almost  beyond  the  reach  of  medicine. 
But  its  fatality,  even  in  this  stage,  has  undoubtedly  been  in- 
creased by  the  evil  genius  of  empiricism,  having  been  too  fre- 
quently allowed  to  usurp  the  throne  of  reason  and  preside  over 
its  treatment.  The  terror  and  wonder  excited  by  the  rapid 
approach  and  onset  of  “ the  pestilence  walking  in  darkness,” 
have  deprived  many  of  the  profession  of  their  philosophy,  and 
led  them  to  overlook  the  almost  entire  similarity  in  the  train 
of  symptoms  presented  in  this  stage,  and  that  which  threatens 
death  in  a host  of  other  maladies.  These  remarks  are  by  no 
means  of  general  application,  and  the  records  of  medical  sci- 
ence bear  testimony  to  the  deep  interest  and  skill  with  which 
the  profession  have  prosecuted  their  researches  into  the  nature 
and  treatment  of  the  epidemic.  The  great  discrepancy,  how- 
ever, in  the  various  methods  of  cure  proposed  by  the  different 
writers  on  the  disease,  renders  it  exceedingly  difficult  for  one 
who  has  never  before  witnessed  it,  to  conduct  the  remedies 
upon  those  rational  principles  which  flow  from  a knowledge 
of  the  pathology  of  other  complaints,  and  govern  their  treat- 
ment. If,  however,  this  stage  of  the  disease  is  produced  by 
the  large  discharges,  the  obvious  indications  are,  when  these 
have  ceased, 

1.  To  restore  to  the  heart  and  blood  vessels  the  stimulus 
of  distention,  by  supplying  them  with  the  fluids,  and  neutral 
salts,  of  which  they  have  been  deprived. 

2.  To  sustain  the  sinking  powers  of  life,  and  combat  acci- 
dental symptoms. 

(a)  Water  is  the  principal  ingredient  of  which  the  blood 
has  been  deprived,  and  this  fluid  being  essential  to  the  per- 
formance of  all  the  functions  of  life,  it  becomes  a matter  of 
the  highest  importance  to  restore  this  to  the  blood  vessels. 
The  instinctive  call  of  the  patient,  while  utterance  remains, 
points  to  it  as  the  most  grateful,  as  it  is  the  most  useful,  reme- 
dy we  can  employ.  It  should  be  generally  given  warm,  un- 
less it  too  much  increases  the  serous  discharges  from  the  in- 
testines or  skin.  The  grateful  taste  of  cold  water,  however, 


104 


Spencer  on  Asiatic  Cholera. 


or  even  ice  water,  may  at  times  be  properly  indulged,  especi- 
ally if  a passive  vomiting  or  purging  continues.  They  are 
often  the  most  efficient  remedies  we  possess  for  allaying  those 
symptoms.  While  such  extreme  coldness  of  the  internal  and 
external  parts  exists,  warmth  properly  graduated,  is,  how- 
ever, decidedly  indicated.  Rice  water,  chicken  tea,  toast,  or 
gum  arabic  water,  being  mildly  nourishing,  constitute  proper 
drinks.  With  a view  to  the  restoration  of  the  neutral  salts, 
of  which  the  blood  has  been  deprived,  these  may  be  combined 
with  the  drinks,  if  the  stomach  will  retain  them.  The  for- 
mula of  Dr.  Stevens,  consisting  of  muriate  of  soda  1 scruple, 
carb.  of  soda  \ a dr.  and  chlorate  of  potass  grs.  7,  dissolved  in  a 
tumbler  of  water,  and  repeated  every  half  hour  or  hour,  ap- 
pears well  calculated  to  accomplish  this  object.  Or,  the  pre- 
scription of  Dr.  Harris  of  Philadelphia,*  consisting  of  sup. 
carb.  of  soda  dr.  1,  mur.  of  soda  scrup.  1,  chlor.  of  potass  grs.  8, 
water  oz.  4,  may  be  employed,  and  is  said  to  have  been  found 
highly  useful.  A simple  solution  of  common  salt,  or  com- 
bined with  the  other  neutral  salts,  with  starch,  as  the  vehi- 
cle, may  be  used  as  an  enema,  which  should  be  drawn  off  with 
a tube,  and  repeated  at  like  intervals.  Should  they  tend  to 
run  off,  they  should  be  retained  by  the  means  recommended  in 
the  second  stage.  If,  however,  these  neutral  salts  are  found 
to  keep  up  or  augment  the  serous  discharges  from  the  bowels, 
they  are  obviously  contra-indicated,  and  aqueous  fluids  alone, 
or  slightly  impregnated  with  nitric  acid,  as  advised  by  Mr. 
Annesly,  or  combined  with  camphorated  spirits,  should  be 
used.  Even  these  ought  likewise  to  be  emplo}red  according 
to  the  effect  they  produce,  requring  at  times  to  be  sparingly 
used,  or  their  employment  suspended,  as  in  the  second  stage, 
when  the  stomach  and  bowels  need  to  be  tranquilized.  A 
heavy  covering  of  bed  clothes,  which  fatigue  the  patient,  and 
induce  profuse  sweating,  is  obviously  improper.  Coldness  of 
the  surface  is  one  mean  of  supplying  the  heart  with  fluids,  and 
while  vitality  continues,  the  skin  being  less  essential  to  life 


* Mentioned  by  Professor  Revere  of  Jefferson  College,  in  his  lectures 


Spencer  on  Asiatic  Cholera. 


105 


than  the  function  of  the  internal  organs,  should  not  be  too 
much  heated.  Professor  Jackson  mentioned  that  he  had  ap- 
parently derived  great  advantage  from  external  frictions  with 
ice,  and  Mr.  Ainsworth  of  Berlin,  speaks  of  the  utility  of  cold 
effusions  in  this  stage.  I have  seen  this  used  but  in  one  in- 
stance, and  then  with  no  apparent  advantage.  It  appears  ra- 
tional to  conclude  that  this  remedy  would  be  indicated  only 
in  those  cases  of  collapse  suddenly  induced  by  the  discharges, 
when  they  had  not  been  very  profuse  ; and  that  it  would  be 
injurious  when  the  system  had  more  gradually  succumbed  to 
immense  discharges.  This  remedy  was  likewise  employed 
in  some  of  the  French  hospitals,  with  apparent  advantage. 
(See  case  12.)  But  here  proper  bounds  must  be  observed, 
and  coldness  of  the  surface  should  by  no  means  be  suffered  to 
proceed  too  far.  Occasional  frictions  with  hot  flannel  and 
chalk,  or  the  flesh  brush,  or  some  stimulating  embrocation,  as 
the  ammoniated  oil,  or  this  mixed  with  tincture  of  canthari- 
des  or  capsicum,  are  obviously  proper  to  rouse  the  action  of 
the  skin,  but  great  care  should  be  exercised  not  to  carry  this 
to  the  extent  of  too  much  fatiguing  the  patient,  or  the  feeble 
glimmerings  of  the  vital  spark  will  be  thus  extinguished.  Too 
much  may  be  done  in  this  stage.  The  patient  should  not  be 
suffered  to  dose  too  long.  When  the  respiration  is  slowly, 
and  with  difficulty  performed,  voluntary  exertion  often  aids 
this  function.  But  on  the  contrary,  if  quiet  sleep  locks  the 
senses  of  the  patient,  this  should  not  be  too  soon  interrupted, 
since,  during  that  state,  the  recuperative  powers  of  the  sys- 
tem are  at  all  times  most  vigorously  displayed. 

Venous  injections  constitute  another  source  for  fulfilling 
the  first  indication,  but  their  utility  does  not  seem  as  yet 
to  be  placed  upon  a certain  foundation.  This  method  of 
administering  remedies  had  been  alternately  practised  and 
abandoned  by  medical  men,  long  before  the  appearance  of 
the  present  epidemic.  High  expectations  were  at  first 
raised  by  the  wonderful  effects  displayed  from  the  use  of 
this  remedy  ; patients,  apparently  iu  the  last  moments  of 
life,  being  so  far  resuscitated,  that  they  were  able  at  once  to 


106 


Spencer  on  Asiatic  Cholera . 


present  the  appearance  of  a being  possessing  the  vigorous 
exercise  of  all  the  functions  of  animated  existence.  (See 
case  11.)  Such  expectations  have,  however,  been  but  too 
often  raised  to  be  suddenly  disappointed,  patients  soon  sink- 
ing irrecoverably  into  the  grave.  Perhaps  the  too  rapid  man- 
ner in  which  these  have  been  thrown  into  the  veins,  may  be 
one  reason  for  this  sudden  failure,  the  enfeebled  energies  of 
the  heart  being  overwhelmed  by  the  inordinate  and  high  ex- 
citation they  produce,  or  the  balance  of  the  circulation  may 
be  destroyed,  from  the  fluids  becoming  detained  in  the  dis- 
tended veins,  by  the  use  of  these  stimulants.  This  would 
suggest  the  propriety  of  the  very  slow  introduction  of  fluids, 
and  their  suspension  as  soon  as  the  system  begins  to  rally. 
It  may  likewise  be  suggested,  that  as  these  injections  must 
act  in  a great  measure  by  the  stimulus  of  distention,  water, 
unmixed  with  neutral  salts,  might  be  safer,  and  answer  the 
purpose  of  rousing  the  action  of  the  heart.  I cannot  speak, 
however,  from  experience  on  this  point,  having  never  seen  the 
effect  of  venous  injections,  unless  they  contained  neutral  salts. 
Great  care  should  be  exercised  when  venous  injections  are 
used,  to  avoid  the  introduction  of  air  into  the  veins.*  In  de- 
tailing our  means  for  fulfilling  the  second  indication , perhaps 
one  of  the  most  difficult  problems  in  the  practice  of  medicine 
needs  to  be  solved — the  appropriate  exhibition  of  stimulants. 
No  question  is  more  perplexing  to  the  young  practitioner  of 
medicine,  than  to  learn  when  his  depleting  remedies  require 
to  be  exchanged  for  those  calculated  to  sustain  or  rouse  the 
vital  energies  ; and  even  those  who  have  the  lights  of  obser- 
vation and  experience  as  a guide,  are  often  obliged  to 
feel  on  this  subject  a painful  uncertainty.  In  the  dis- 
ease under  consideration,  it  may  be  emphatically  said, 
that  “ in  avoiding  Scylla,  we  are  often  driven  upon  Cha- 
rybdis.”  By  resorting  to  the  too  free  use  of  stimulants,  there 
is  danger  of  suddenly  suspending  the  action  of  the  heart,  or 

* On  the  use  of  this. remedy,  however,  I most  fully  concur  with  the  opinion  ex- 
pressed by  Dr.  Greenhow,  that  “ the  recoveries  which  have  taken  place,  ousrht 
more  properly  to  be  considered  as  having  occurred  in  spite,  than  in  consequence  of 
the  treatment.” 


Spencer  on  Asiatic  Cholera. 


107 


producing  consecutive  fever,  which  is  indeed  by  some  consid- 
ered “ more  hazardous  than  the  collapse.”  Entirely  to  with- 
hold them,  is  frequently  to  see  the  patient  rapidly  and  irrecov- 
erably sink.  Much  diversity  of  opinion  obtains  among  med- 
ical men  upon  this  difficult  point.  Some  strenuously  insist 
on  the  use  of  active  stimulants,  while  others  as  earnestly  con- 
tend for  their  entire  exclusion  from  our  remediate  means. 
It  is  believed  that  the  middle  course  will  be  found  nearest 
right.  An  important  axiom  in  medicine  needs  to  be  kept  in 
view  in  regulating  the  quantity  of  stimulants  in  this  stage,  to 
wit  : “ that  it  requires  much  less  doses  of  medicine  to  cure 
debility  than  diseased* 

This  may  he  exemplified  by  a reference  to  typhus  fever, 
when  in  the  advanced  stage  immense  doses  of  wine  and  stim- 
ulants are  required  to  sustain  the  diseased  and  enfeebled 
functions  of  life  ; but  when  the  fever  is  suspended,  the  quan- 
tity of  stimulants  may  be  very  promptly  lessened,  without 
endangering  the  patient. 

If  the  view  taken  of  the  nature  of  this  disease  be  cor- 
rect, we  have  in  this  stage  debility,  not  disease,  to  contend 
with — hence  the  moderate  use  of  stimulants  would  be  the  ob- 
vious indication.  Perhaps  the  best  general  rule  that  can  be 
laid  down  is,  the  less  stimulants  we  use  the  better , provided 
sufficient  are  employed,  to  sustain  life.  But  the  difficulty  of 
conforming  to  this  rule  must  be  obvious.  Camphor  and  carb. 
ammonia  are  among  the  most  valuable  stimulants,  as  these 
are  not  so  liable  to  produce  consecutive  fever,  as  some  others 
often  employed.  The  exhibition  of  camphorated  spirits  in 
small  and  repeated  doses,  in  a wine  glass  full  of  warm  water, 
as  proposed  by  Hahnemann,  is  proper  and  generally  grate- 
ful to  the  stomach.  Camphor  does  not  excite  a very  powerful 
action  of  the  heart. 

It  is  however,  believed,  that  the  warm  water  is  in  this  pre- 
scription more  decidedly  useful  than  the  camphor,  by  supplying 
the  blood  vessels  with  this  important  agent.  Small  doses  of 
carbonate  of  ammonia,  dissolved  in  a solution  of  gum  arabic. 


* Ruth. 


10S  Spencer  on  Asiatic  Cholero. 

alternated  with  the  doses  of  camphor,  by  a change  of  stim- 
ulus, may  be  advantageously  employed.  The  capsicum  has 
many  respectable  advocates,  both  as  an  internal  and  external 
remedy,  but  I cannot  speak  from  personal  observation  of  its 
effects.  A combination,  however,  of  quinine  and  piperine, 
in  the  proportion  of  a grain  or  two  of  the  former,  to  | gr.  of 
the  latter,  by  keeping  up  the  tone  of  the  enfeebled  stomach, 
has  been  at  limes  advantageously  employed,  given  at  inter- 
vals of  half  an  hour  or  an  hour.  Wine  or  brandy  are  stim- 
ulants to  which  it  may  be  necessary  to  resort,  should  the 
others  disappoint  our  expectations.  Port  or  Madeira  wine 
may  be  added  to  the  drinks,  but  administered  with  the  en- 
emata,  they  often  answer  every  purpose.  From  a spoonful 
to  a wine  glass  added  to  the  starch,  or  with  the  saline  in- 
jections, may  be  thrown  into  the  intestines  hot,  and  repeated 
every  hour  or  two,  should  the  symptoms  require  it.  These 
injections  should  be  drawn  off  by  a tube,  previous  to  each  re- 
petition. Brandy  has  been  employed  for  like  purposes,  and 
although  it  is  believed  not  in  general  so  useful  as  wine,  it 
should  by  no  means  be  overlooked  among  our  resources  in 
this  disease.*  On  commencing  the  use  of  stimulants  in  the 
collapse,  I observed  at  times  a sudden  increase  of  the  energy 
of  the  pulse,  with  increasing  warmth ; but  these  effects,  like 
those  from  venous  injections,  were  frequently  of  short  dura- 
tion, and  the  patient  sunk  more  suddenly  than  could  have 
been  expected  without  their  employment.  This  led  me  to 
the  following  reflections  on  the  modus  operandi  of  stimulants, 
which  is  submitted  only  for  what  it  is  worth.  The  heart  is 
believed  by  physiologists  to  be  the  principal  organ  of  the  cir- 
culation of  the  blood,  although  a division  of  opinion  exists 
as  to  the  agency  that  the  arteries  and  veins  have  in  the  per- 
formance of  this  function,  some  supposing  they  are  merely 
elastic  tubes,  in  which  the  blood  is  circulated,  by  the  force  of 
the  heart  alone,  others  believing  that  they  possess  muscular 


* See  Dr.  Kirk,  on  the  use  of  (his  remedy. 


Spencer  on  Asiatic  Cholera . 109 

powers,  by  which  they  aid  this  function.  It  is,  however,  ad- 
mitted that  the  coats  of  the  veins  are  much  weaker  than  those 
of  the  arteries,  and  that  their  elastic  or  contractile  power, 
(which  ever  they  possess)  is  also  much  less.  In  the  disease 
under  consideration,  the  immense  discharges  greatly  lessen  the 
volume  of  circulating  fluids.  In  proportion  as  the  living 
powers  are  diminished,  the  functions  of  the  system  become 
more  and  more  under  the  influence  of  physical  laws.  The 
heart  and  blood  vessels  constitute  the  most  perfect  hydraulic 
machinery  in  nature,  balanced  in  health  by  the  incomprehen- 
sible principle  of  life.  Let  us  now  suppose  the  balancing 
principle  greatly  lessened,  and  the  fluids  to  be  diminished  in 
volume,  as  evidently  happens.  At  the  same  time  allow  a 
great  increase  of  the  principal  motive  power,  by  augmenting 
the  energies  of  the  heart  by  stimulants,  what  should  we  ex- 
pect ? Would  not  the  fluids  be  driven  into  and  retained  in 
the  weakest  parts  of  the  tubes  conveying  them  ? If  they 
would,  the  arteries  being  the  stronger  tubes,  would  become 
empty,  and  the  veins  being  much  the  weaker  parts  of  the  cir- 
culating machinery,  would  become  readily  distended,  thus 
detain  the  blood,  and  thereby  cut  off  the  supply  of  this  fluid 
to  the  heart.  If  the  supply  of  blood  to  the  heart  be  thus  in- 
directly interrupted  by  stimulants,  we  can  very  rationally  ac- 
count for  the  sudden  suspension  of  its  action  from  their  em- 
ployment, and  hence  deduce  an  important  practical  precept 
in  the  use  of  stimulants.  If  stimulants  are  administered,  they 
should,  therefore,  be  commenced  moderately,  and  their  effects 
should  be  carefully  watched.  When  commenced,  if  the  pulse 
is  found  suddenly  to  return  to  the  wrist,  after  it  has  for  a time 
ceased  to  beat,  or  becomes  greatly  augmented  in  frequency  or 
force,  and  the  respiration  becomes  oppressed,  the  stimulants 
are  certainly  doing  injury.  On  the  contrarv,  if  the  pulse  be- 
comes slower,  or  remains  nearly  stationary  in  frequency, 
gradually  increasing  in  strength,  and  if  at  the  same  time  the 
profuse  sweating,  which  attends  this  stage,  gradually  abates, 
and  the  corrugation  of  hands  subsides,  a perseverance  in  stim- 

15 


HO  Spencer  on  Asiatic  Cholera, 

ulants  is  indicated.  Patients  should  be  carefully  admonish- 
ed in  this  stage  not  to  make  use  of  much  voluntary  exertion 
or  rise  into  an  erect  posture,  (a  power  they  sometimes  retain) 
since  swooning  or  sudden  death  are  occasionally  produced  by 
such  exertions. 

On  the  use  of  emetics,  when  complete  collapse  has  super- 
vened, I cannot  speak  from  personal  observation,  although  I 
can  bear  testimony  to  their  great  utility  when  the  powers  of 
the  system  appeared  closely  to  approximate  to  this  stage. 
Apprehensions  have  been  entertained  that  the  system  would 
not  bear  the  shock  of  this  remedy,  but  these  prejudices  may 
be  ill  founded.  Mustard  and  muriate  of  soda  have  been 
stronglv  recommended,  and  even  the  use  of  other  emetics  has 
been  advocated.*  In  cases  when  the  collapse  has  been  sud- 
denly induced  by  the  severe  discharges,  they  must  be  obvious- 
ly more  proper  than  when  the  system  has  slowly  yielded  to 
more  extensive,  but  less  rapid,  evacuations. 

Opiates  have  been  employed  by  some,  and  perhaps  demand 
a notice  of  their  uses  and  abuses  in  this  stage  of  the  disease. 
Laudanum,  and  other  forms  of  opium,  have  been  much  used 
since  the  days  of  Sydenham,  for  the  cure  of  common  cholera 
morbus,  which  disease  has  been  considered  by  most  of  the 
profession  as  constituting,  in  an  aggravated  form,  the  present 
epidemic.  This  has  led  to  their  very  extensive  employment 
as  the  principal  remedies  in  this  disease,  but  experience  has 
certainly  proved  their  general  use  injurious.  A strong  ten- 
dency is  manifested  at  an  early  period  for  the  fluids  that  gen- 
erally find  an  outlet  at  the  kidneys  to  pass  off  by  the  bowels, 
as  is  evinced  by  the  scanty  urine,  and  difficulty  of  making 
water.  Perhaps  no  medicine  so  suddenly  suspends  the  urin- 
ary function  as  opium,  and  hence  its  great  utility  in  many 
cases  of  diabetes.  An  intimate  connection  appears  to  exist 
between  the  functions  of  the  kidneys  and  brain,  it  being  gen- 
erally remarked,  that  a suppression  of  urine  for  three  or  four 
days  produces  a termination  in  fatal  coma.  In  the  present 
disease,  this  tendency  to  suppressed  urine  must  be  olten  aug- 

* See  ail  Essay  by  C.  C.  Yates,  Bl.  D. 


Spencer  on  Asiatic  Cholera. 


lit 


merited  by  the  use  of  opiates,  and  the  frequent  return  of  the 
diarrhoea,  when  suppressed  by  this  medicine,  indicates  that 
their  effects  upon  the  bowels  are  lost  much  sooner  than  upon 
the  kidneys.  It  is  believed  that  the  use  of  opiates  has  been 
the  principal  cause  of  the  entire  suppression  of  urine,  which 
has  followed  the  collapse  of  this  disease,  and  the  tendency  to 
fatal  affections  of  the  head,  in  the  consecutive  fever,  may  ra- 
tionally be  referred  to  this  interruption  of  the  urinarv  dis- 
charge. I am  the  more  inclined  to  this  belief,  from  the  en- 
tire exemption  from  fever  of  those  treated  with  emetics  and 
sudorifics  in  the  second  stage,  and  the  prompt  return  of  the 
urinous  secretion  in  such  cases,  and  the  almost  certain  train 
of  febrile  and  comatose  symptoms  which  followed  the  exten- 
sive use  of  opiates  and  other  stimulants.  In  protracted  cases 
of  ischuria,  we  almost  always  have  a train  of  symptoms  re- 
sembling the  comatose  condition  of  typhus.  May  we  not 
conclude  that  comatose  affections  are  often  connected  with 
deranged  urinary  secretion  ? The  fact  is  well  established  that 
the  action  of  opiates  upon  the  skin,  greatly  diminish  the  dan- 
ger of  their  producing  comatose  symptoms,  and  it  is  believed 
their  employment  in  the  present  epidemic  would  have  been 
rendered  much  safer  if  pains  had  been  taken  uniformly  to  in- 
vite their  action  upon  the  cutaneous  exhalents.  Their  use 
may  likewise  be  rendered  much  safer  by  combining  or  follow- 
ing them  with  spirits  of  nitre,  and  other  medicines  which 
promote  urinary  secretions.  When  the  evidences  of  reaction 
begin  to  display  themselves  by  the  gradual  restoration  of  the 
vigour  of  the  pulse,  by  respiration  becoming  more  full  and 
free,  by  the  gradual  return  of  warmth  and  dimunition  of  the 
profuse  sweating  and  corrugation  of  hands,  it  becomes  highly 
important  so  to  conduct  this  period  as  to  prevent  the  estab- 
lishment of  consecutive  fever.  The  blood  vessels  have  now 
so  far  contracted  down  upon  their  contents  as  no  longer  to 
have  their  functions  interrupted  from  want  of  the  stimulus 
of  distention,  but  the  whole  capillary  system  of  the  body  has 
been  in  the  lowest  state  of  life  compatible  with  the  contin^ 
nance  of  vitality,  and  are  liable  to  become  irregular  in  thei? 


112  Spencer  on  Asiatic  Cholera , 

,actions3  presenting  coldness  of  one  part,  while  heat  may  be 
developed  in  another.  In  this  condition  warmth  should  be 
applied  to  the  colder  parts,  while  if  the  heat  of  any  other 
part  becomes  inordinate,  it  should  be  moderated  by  exposure 
to  cool  air  or  ablutions.  Perhaps  nothing  is  more  important 
than  the  entire  suspension  of  stimulants,  as  soon  as  life  can 
be  sustained  without  them,  such  is  the  propensity  of  all  the 
.organs  of  the  body  to  be  roused  to  inordinate  or  irregular  ac- 
tions, after  their  functions  have  for  a time  been  almost  sus- 
pended. It  would  seem  equally  rational  to  apply  and  con- 
tinue heat  and  stimulants  to  the  surface  of  a frozen  limb,  to 
restore  its  healthy  actions,  as  by  the  active  employment  of  the 
same  means  to  rouse  and  preserve  the  healthy  balance  of  all 
the  functions  of  life,  after  they  have  been  in  the  lowest  state 
of  existence.  In  the  collapse,  following  great  hemorrhages, 
few  physicians  would,  at  the  present  day,  persevere  in  the 
use  of  stimulants  after  the  system  presented  the  evidence  of 
returning  animation,  and  the  marked  similarity  of  the  condi- 
tion of  the  system,  in  the  two  cases,  has  been  already  noticed. 
In  this  stage,  some  narcotic,  as  extract  of  hop  or  hyoscyamus, 
or  a few  drops  of  laudanum,  combined  with  spirits  of  nitre, 
may  be  given  to  allay  the  great  irritability  of  the  nervous 
system,  which  sometimes  exist.  These,  followed  by  warm 
diluents,  so  as  to  keep  up  a moderate  action  of  the  cutaneous 
exhalents,  will  tend  to  guard  against  the  return  of  the  intesti- 
nal disease,  as  well  as  the  developement  of  fever,  but  re- 
quire to  be  carefully  graduated  to  the  condition  and  powers 
of  the  system.  Mild  diuretics  should  be  administered,  and 
half  grain  doses  of  calomel  every  two  hours,  may  be  properly 
given  to  restore  the  healthy  peristaltic  motions  of  the  bowels, 
and  act  upon  the  biliary  organs.  Should  the  reaction  become 
too  high,  threatening  to  terminate  in  fever,  no  time  should  be 
lost  in  administering  a more  active  laxative,  such  as  a few 
grains  of  calomel  combined  with  rhubarb  or  castor  oil.  The 
highly  susceptible  condition  of  the  intestinal  membrane, 
should,  however,  be  borne  in  mind,  and  caution  be  observed 
not  to  carry  the  remedies  to  the  extent  of  reproducing  the 
original  disease. 


Spencer  on  Asiatic  Cholera. 


113 


So  multifarious  have  been  the  remedies  prescribed,  or  pub- 
lished as  specifics  in  this  disease,  that  to  examine  each  in  de- 
tail would  of  itself  require  an  extended  volume.  F have, 
therefore,  confined  myself  principally  to  the  consideration  of 
those,  which,  in  my  view,  have  the  highest  claim  to  con- 
fidence. 


CHAPTER  XII. 

OF  THE  TREATMENT  OF  CONSECUTIVE  FEVER. 

In  all  febrile  diseases,  there  are  two  great  sources  of  outlet 
to  life — disorganization  and  debility.  The  first  probably  con- 
stitutes the  largest  proportion : a numerous  class  of  organs  on 
which  life  unceasingly  depends,  being  all  liable,  in  the  pro- 
gress of  fever,  to  be  attacked  with  inflammation,  which  may 
destroy  their  texture.  Debility  becomes  the  outlet  of  life,  by 
the  gradual  exhaustion  of  the  vital  energies,  or  by  being  in- 
duced by  sudden  hemorrhage  or  discharges  from  some  of  the 
excretory  organs  of  the  body.  In  the  fever  under  considera- 
tion, it  must  be  borne  in  mind  that  we  have  one  of  a low  type, 
and  both  debility  and  disease  to  combat ; and  hence  it  becomes 
a matter  of  the  highest  moment  to  preserve,  as  far  as  possible, 
the  vital  fluids,  and  at  the  same  time  promptly  relieve  the 
threatened  destruction  of  any  important  organ.  The  patholo- 
gy of  fever  being  foreign  from  our  present  subject,  it  may  be 
allowable  to  state  that  the  indications  of  treatment  should  be 
drawn  from  our  observance  of  those  operations  of  nature,  by 
which  is  produced  a natural  cure  of  fever.  These  are  free 
perspiration,  hemorrhage,  diarrhoea,  and  copious  discharges 
from  the  kidneys  or  lungs.  This  fever  is  to  be  treated  upon  gen- 
eral principles  ; but  from  the  natural  means  by  which  a solu- 
tion of  fever  is  so  frequently  procured,  may  be  deduced  the 
following  indications  : 


114 


Spencer  on  Asiatic  Cholera. 


1.  By  an  imitation  of  nature,  in  her  hemorrhagic  efforts  tc 
keep  the  actions  of  the  heart  and  arteries  within  those  bounds 
which  guard  against  excessive  reaction  and  disorganization, 
at  the  same  time  observing  those  limits  which  will  prevent 
danger  from  debility. 

2.  To  act  upon  the  four  excretory  functions,  and  restore 
their  healthy  performance.  3.  To  sustain  the  powers  of  the 
system  and  combat  untoward  symptoms.  For  fulfilling  the 
first  indication,  blood  letting,  both  general  and  local,  is  the 
most  efficient  remedy,  and  is  more  under  our  prompt  and  im- 
mediate control  than  any  other.  But  in  its  use  much  dis- 
crimination is  required  to  keep  within  the  range  of  the  indica- 
tion as  laid  down.  The  blood  vessels  having,  by  this  time, 
accommodated  themselves  to  their  remaining  contents,  less 
apprehensions  need  be  indulged  of  inducing  debility,  than 
would  at  first  view  be  entertained.  This  remedy  should  gen- 
erally be  restricted  to  those  cases  giving  evidence  of  local 
disease  of  some  important  organ.  In  such  cases,  bleeding 
may  be  hazardous,  but  to  omit  it  is  inevitable  death.  No 
general  rules  can  of  course  be  laid  down  for  graduating  the 
quantity  which  should,  with  the  other  means,  be  carried  to 
the  extent  of  promptly  relieving  the  local  disease.  Although 
in  such  cases  the  system  cannot  sustain  large  and  repeated 
bleedings,  it  may  readily  recover  from  the  temporary  collapse 
of  pretty  free  ones,  when  the  local  disease  first  begins.  Lo- 
cal blood  letting  is  obviously  more  important  in  this  fever 
than  it  is  when  inflammatory  disease  attacks  those  in  previous 
good  health.  In  the  cases  attended  with  excessive  febrile  reac- 
tion, without  local  disease,  bleeding,  if  employed  at  all,  should 
be  moderate,  confiding  principally  in  other  remedies.  Position, 
when  there  is  local  disease  of  the  head  or  lungs,  becomes,  in 
this  disease,  highly  important,  and  the  half  sitting  posture 
should  be  directed.  To  fulfil  the  second  indication,  the  para- 
mount object  should  be  to  act  upon  the  skin,  since  by  inducing; 
perspiration,  we  more  promptly  equalize  the  distribution  of 
the  circulating  fluids,  than  by  any  other  means.  In  the  fever 


Spencer  on  Asiatic  Cholera. 


115 


'under  consideration,  there  is  often  a great  determination  to 
one  portion  of  the  body,  while  there  seems  to  be  lessened  vas- 
cular action  in  another.  The  cold  effusion  and  emetics  stand 
at  the  head  of  our  means  for  promptly  acting  upon  the  skin,  in 
all  febrile  diseases.  Properly  combined  and  aided  by  the  use 
of  warm  diluents,  they  are  among  our  most  efficient  means  of 
arresting  febrile  diseases,  or  of  putting  them  in  a safe  train.  But 
they  cannot  be  used  in  all  conditions  of  the  system,  and  like 
every  thing  else,  must  be  employed  or  omitted  according  to 
existing  circumstances.  When  the  skin  is  hot  and  dry,  and 
there  exists  no  serious  inflammatory  affection  of  the  thoracic 
or  abdominal  viscera,  the  cold  effusion  may  be  unhesitatingly 
employed.  In  this  fever  the  constitutional  energies  being  en- 
feebled by  previous  disease,  care  should  be  taken  to  ensure 
reaction.  With  this  view,  the  extremities  should  be  smartly 
rubbed  with  hot  flannel  previous  to  the  application,  and  the 
patient  should  be  subsequently  put  into  hot  flannel  sheets. 
The  previous  exhibition  of  some  diffusible  stimulant,  as  ether, 
camphor,  or  warm  sangaree,  is  likewise  proper.  A pail  of 
cold  water  should  be  poured  over  the  whole  body  of  the  pa- 
tient, from  a height  of  some  three  or  four  feet,  and  he  should 
then  be  wiped  dry  with  warm  flannel.  A few  grains  of  ipe- 
cac may  now  be  administered,  followed  by  some  warm  dilu- 
ents to  promote  emesis  and  diaphoresis — (see  cases  13  and 
14.)  Should  the  stomach  not  be  readily  acted  upon  by  the 
ipecac,  its  operation  may  be  promoted  by  the  use  of  eupato- 
rium,  chamomile  or  diffusible  stimulants,  as  recommended  in 
the  treatment  of  the  second  stage.  If  the  powers  of  the  sys- 
tem are  deemed  insufficient  to  withstand  the  shock  of  the 
cold,  the  tepid  affusion  may  be  substituted.  The  presence  of 
local  disease  of  the  head,  constitutes  no  objection  to  the  use 
of  the  cold  affusion,  on  the  contrary,  we  are  possessed  of 
few  remedies  of  more  utility  in  its  inflammatory  diseases. 
These  complaints  being  frequently  attended  with  cool  sur- 
face, an  exception  to  the  general  rule  of  requiring  a hot  skin 
for  the  use  of  the  cold  affusion,  may  here  be  found.  (Case 
16.)  Notwithstanding  the  ample  testimony  of  medical  wri- 


1 16 


Spencer  on  Asiatic  Cholera . 


ters  in  favor  of  this  potent  remedy,  in  febrile  diseases,  it  is 
quite  too  rarely  and  timorously  employed  by  the  generality 
of  medical  practitioners.  Should  the  means  above  detailed 
fail  to  relieve  the  fever,  or  should  local  disease  of  the  head  or 
lungs  exist,  we  may  simultaneously  act  upon  the  four  excre- 
tory functions  of  the  body  by  a powder  composed  of  calomel, 
cream  tartar  and  emetic  tartar.  Emetic  tart,  and  ipecac  are 
generally  allowed  to  exert  a specific  action  upon  the  skin  and 
lungs ; calomel  exerts  a specific  influence  upon  the  actions 
of  the  intestines  and  liver,  and  we  possess  few  articles  more 
active  in  promoting  the  urinary  secretion  than  cream  tartar, 
especially  in  a febrile  condition  of  the  system.  The  urinary 
secretion  being  generally  suspended  in  this  fever,  it  becomes 
a matter  of  paramount  importance  to  restore  it,  or  fatal  coma 
too  frequently  supervenes.  By  combining  these  three  articles, 
we  have  one  of  the  most  active  anti-inflammatory  combina- 
tions. A powder  of  calomel,  1 or  2 grains  emetic  tartar,  \ 
gr.  cream  tartar,  8 or  10  grs.  may  be  given  every  2 or  3 hours, 
at  the  same  time  spts.  nitre  and  mucilages  are  employed. 
(Case  15.)  When  the  powers  of  the  system  are  much  en- 
feebled, the  emetic  tartar  should  be  exchanged  for  the  ipecac, 
and  camphor  may  often  be  advantageously  added  to  the  pow- 
der. When  there  is  severe  affection  of  the  head,  the  cal- 
omel may  be  increased  to  5 or  6 grains  in  each  powder,  with- 
out the  danger  of  inducing  too  much  catharsis,  (Case  16) 
and  with  manifest  benefit  to  the  patient.  If  these  should  not 
prove  sufficiently  laxative,  some  aperient  may  be  administer^ 
ed,  as  rhubarb  or  castor  oil.  If  in  the  progress  of  the  fever, 
large  discharges  from  any  organ  should  take  place,  they  should 
be  promptly  arrested,  and  care  must  be  exercised  not  to 
carry  our  depleting  remedies  too  far.  Stimulants  and  tonics 
must  necessarily  be  resorted  to,  if  the  constitutional  powers 
become  too  much  enfeebled,  and  should  by  no  means  be  too 
long  delayed,  if  convinced  that  their  effects  should  determine 
the  propriety  of  their  continuance.  When  they  produce,  in- 
stead of  moderating  delirium ; when  they  augment,  instead 
of  lessening,  the  frequency  of  the  pulse  ; when  the  skin  be- 


Spencer  on  Asiatic  Cholera.  117 

comes  hotter  and  dryer,  instead  of  becoming  soft  and  perspir- 
ablej  and  the  respiration  becomes  hurried  and  difficult,  by 
their  use,  attended  with  pain  or  oppression  at  the  precordia, 
they  should  be  laid  aside.  When  opposite  effects  are  produc- 
ed, a perseverance  in  them  is  indicated.  In  the  treatment  of 
this  febrile  affection,  however,  nothing  peculiar  is  demanded, 
except  a proper  adaptation  of  the  remedies  to  the  varying 
conditions  of  the  system,  as  indicated  by  the  developing  symp- 
toms* Indeed,  this  constitutes  the  great  secret  of  all  diseases. 
An  attempt  has  been  made  to  place  our  remediate  means  in 
all  the  stages  of  the  epidemic,  upon  the  same  basis,  with  what 
success,  is  respectfully  submitted  to  the  decision  of  this  en- 
lightened society. 

Gentlemen  of  the  Society — 

Allow  me  to  turn  for  a moment,  from  the  contemplation  of 
a disease  which  has  spread  such  general  devastation,  to  some 
individual  instances  of  mortality,  deeply  affecting  the  interests 
of  the  medical  profession.  Since  the  last  meeting  of  this  so- 
ciety, two  of  its  aged  and  distinguished  members  and  former 
presidents,*  have  yielded  to  the  obliterating  hand  of  time. 
Although  this  is  not  the  place  to  pronounce  their  eulogy,  I 
may  be  indulged  in  taking  a rapid  glance  at  the  principal  in- 
cidents in  the  lives  of  those  who  have  sustained  so  elevated  a 
position,  not  only  among  the  profession  to  which  they  belong- 
ed, but  in  the  public  estimation.  The  high  place  they  held 
in  the  affections  of  their  medical  brethren,  was  evinced  by 
their  election  for  many  years  in  succession,  to  the  Presidency 
of  the  Medical  Societies  of  the  counties  where  they  respective- 
ly resided,  and  of  the  State  Medical  Society.  During  our  re- 
volutionary struggle,  both  participated  in  the  perilous  and  glo- 
rious scenes  of  that  eventful  period.  The  place  of  army  sur- 
geon was  at  this  time  filled  by  Dr.  Rodgers,  who,  although 
young,  was  ably  prepared  for  the  discharge  of  its  responsible 
duties,  by  the  ample  opportunities  he  had  enjoyed  at  the  Uni- 

* Joseph  White,  M.  D.  of  Cherrv- Valley,  and  John  R.  B.  Kodsrers,  M.  D.  of 
New-York. 

16 


118 


Spencer  on  Asiatic  Cholera. 


versity  of  Edinburgh,  where  he  received  the  honors  of  that 
distinguished  medical  school.  He  at  first  settled  in  Philadel- 
phia, hut  afterwards  removed  to  New-York,  where  the  public 
duly  appreciated  his  merits,  and  he  was  called  for  several 
years  in  succession  to  discharge  the  duties  of  health  officer  of 
that  flourishing  city.  He  was  for  many  years  a professor  in 
the  medical  department  of  Columbia  College,  was  subsequent- 
ly appointed  to  a similar  post  in  the  College  of  Physicians  and 
Surgeons,  and  in  the  discharge  of  these,  as  indeed  of  all  the 
public  trusts  committed  to  his  care,  exhibited  the  fullest  proofs 
that  he  had  industriously  improved  the  extensive  advantages 
he  had  enjoyed  for  collecting  medical  intelligence. 

At  the  close  of  the  revolution,  Dr.  White  located  at  Cherry- 
Valley,  then  a frontier  settlement.  Of  him  it  may  be  empha- 
tically said,  that  he  was  the  artificer  of  his  own  fortune.  The 
estimation  in  which  he  wTas  held  by  his  countrymen,  was  at  an 
early  period  evinced  by  his  elevation  to  several  public  offices  ; 
among  which  may  be  mentioned,  his  election  to  the  assembly 
and  the  senate,  where  he  fearlessly  and  satisfactorily  performed 
all  his  duties,  and  aided  the  passage  of  those  acts,  which  have 
so  largely  contributed  to  advance  the  interests  of  medical  sci- 
ence, and  elevate  the  character  of  our  profession  throughout 
the  state.  But  his  strength  and  usefulness  lay  in  his  profes- 
sion, to  which  he  devoted  the  active  energies  of  his  mind.  In 
the  infancy  of  our  country,  he  did  not  enjoy  the  advantages  of 
a medical  education  now  presented  to  the  student  in  our  flou- 
rishing universities,  hut  he  supplied  this  defect  by  a persever- 
ing industry  in  the  pursuit  of  knowledge,  during  the  whole 
period  of  his  life.  Fixing  upon  usefulness  and  eminence  in 
his  profession,  he  attained  an  elevated  rank,  rarely  equalled 
in  any  country. 

For  several  years  he  filled  the  chair  of  surgery  in  the  West- 
ern Medical  College  of  the  state  of  New  York,  where  he  dis- 
played to  his  pupils  the  fruits  of  the  rich  store  with  which  his 
deep  research,  accurate  observation,  and  ample  experience  in 
this  department  of  the  healing  art,  had  furnished  him.  He 
filled  the  place  of  President  of  this  institution  until  the  period 


Spencer  on  Asiatic  Cholera . 


119 


of  his  decease.  In  the  elevated  character  of  these  distinguish- 
ed men,  attained  by  their  indefatigable  perseverance  in  the 
pursuit  of  medical  science,  may  be  found  abundant  cause  to 
stimulate  us  to  emulate  their  illustrious  example,  and  to  de- 
plore the  dispensation  of  that  Providence  which  has  deprived 
the  profession  of  two  of  its  brightest  ornaments. 


APPENDIX. 

Case  1. — M.  F.  iEt.  6S.  Between  August  24  and 
Sept.  1,  had  several  attacks  of  serous  diarrhoea,  checked  by 
opiates,  confinement,  warm  drinks,  followed  by  laxatives  of 
calomel,  combined  with  rhubarb,  or  this  and  magnesia. 
Strength  greatly  reduced. 

Sept.  12. — Taken  the  night  previous  with  profuse  serous 
discharges,  from  the  bowels.  His  strength  rapidly  failing, 
and  no  physician  being  near  the  family,  laudanum  was  ta- 
ken, which  checked  the  disease. 

6,  A.  M.  Found  his  pulse  feeble,  between  80  and  90  in  a 
minute,  skin  cold,  white  slimy  fur  on  the  tongue.  An  emet- 
ic of  ipecac  and  tart,  antimony  was  administered.  This 
failing  to  operate,  5 grs.  sulph.  zinc  and  large  doses  of 
ipecacuanha,  strong  eupatorium  tea,  and  irritation  of  the 
fauces  were  all  employed,  but  no  vomiting.  A glass  of 
port  wine  was  now  given  every  5 or  6 minutes.  Vomiting 
occurred  after  the  3d  glass,  and  the  patient  sweated  moder- 
ately. This  was  promoted  by  hot  sweetened  water,  com- 
bined with  camphorated  spirits,  every  few  minutes  for  three 
hours.  To  be  wiped  dry.  Powders  of  camphor,  cream 
tartar  and  ipecac,  a half  tea  spoonful  of  spirits  of  nitre  and 
the  camphor  and  hot  water  each  every  three  hours  af- 
terwards. 


120 


Spencer  on  Asiatic  Cholera. 


7,  p.  M.  Skin  soft,  pulse  moderate,  no  return  of  dis- 
ease. Gr.  \ calomel,  added  to  each  powder.  Bilious 
stools  soon  returned,  and  port  wine  and  bitter  tea  complet- 
ed the  cure. 

Case  2. — S.  H.  ZEt.  65.  Habitual  drinker,  taken  with 
a milky  diarrhoea,  at  3 o’clock. 

August  28.  6,  a.  M.  Has  had  several  profuse  discharges 

from  the  bowels,  retching  and  vomiting,  tongue  furred,  but 
little  pain,  complains  of  weakness,  pulse  compressible.  Gave 
1 dr.  laud.,  and  an  enema  of  starch  and  laud,  combined 
with  kino.  Chalk  mixture,  laudanum,  and  kino  were  giv- 
en every  2 or  3 hours,  warm  drinks,  dry  heat,  mucilages, 
and  enemas,  to  be  repeated  pro  re  nata. 

Aug.  29,  8 A.  M.  Very  feeble,  profuse  serous  discharg- 
es, peculiar  wail  of  voice,  so  common  in  low  cases,  pulse 
very  feeble,  extremities  cold.  Gave  an  emetic  of  ipecac, 
followed  by  strong  eupatorium  tea,  vomited  5 or  6 times, 
and  sweated  profusely.  Covered  warm  in  bed,  and  took  a 
wine  glass  of  hot  sweetened  water  and  camphorated  spirits 
every  half  hour,  for  three  hours  ; — to  be  wiped  dry  with  hot 
chalk  and  flannel. 

11,  A.  M.  Took  calomel,  gr.  1,  ipecac,  gr.  crem. 
tart.  gr.  8,  camphor,  grs.  3,  every  2 hours,  till  4 were  ta- 
ken, mucilaginous  drinks.  Then  gave  a dose  of  rhubarb 
and  magnesia,  which  operated  in  6 hours,  being  the  first 
movement  of  the  bowels  since  the  emetic.  Dark  bilious 
stools.  Columbo  tea  completed  the  cure. 

Case  3. — J.  I.  L.  JEt.  55.  Attacked  about  the  same 
time  with  similar  symptoms,  as  the  preceding  case.  Sim- 
ilar remedies.  6,  p.  M.  diarrhoea  checked.  Continue  med- 
icines. 

Aug.  29,  9 a.  M.  Symptoms  much  worse,  diarrhoea, 
sickness  at  stomach,  retchings,  cold  extremities,  sunken  eyes. 
Emetic  tartar,  grs.  3,  ipecac,  grs.  30,  one  third  every  15 
minutes  till  vomiting,  and  then  strong  eupatorium  tea.  Af- 
ter vomiting  about  ten  times,  bilious  matter  was  ejected,  and 
patient  perspired  freely.  Followed  by  same  treatment,  and 


Spencer  on  Asiatic  Cholera. 


121 


result  as  in  preceding  case.  The  attack  and  obstinacy  of 
the  continuance  of  this,  and  the  preceding  case,  were  more 
severe  than  several  which  I treated  in  the  usual  method, 
with  opiates,  calomel  and  opium,  confinement,  warm  drinks, 
laxatives,  dry  heat,  but  which  terminated  fatally.* 

Case  4. — Mrs.  U.  iEt.  about  50.  August  29.  9, 

A.  M.  Taken  some  12  hours  before  with  milky  discharg- 
es from  the  bowels,  soon  becoming  serous  and  profuse  ; had 
vomited  several  times,  pulse  feeble,  extremities  becoming 
cold.  A full  emetic  of  em.  tart,  and  ipecac,  with  strong 
eupatorium  tea.  Vomited  severely,  and  profuse  sweating 
soon  came  on.  After  vomiting  some  8 or  10  times,  bile 
was  ejected.  Intestinal  discharges  at  once  ceased.  Gave 
diuretics  and  diaphoretics. 

Aug.  30.  Has  had  bilious  stools.  Soon  recovered. 

Case  5. — I.  S.  JEt.  48.  August  25,  attacked  with 
serous  diarrhoea,  at  times  profuse,  repeatedly  checked  with 
opiates,  followed  by  laxatives,  returning  every  few  hours 
with  increased  violence. 

August  29.  After  a return  of  diarrhoea,  devoid  of  bile, 
for  several  hours,  taken  with  severe  vomiting  of  rice-colour- 
ed fluid,  pulse  accelerated  and  feeble  ; countenance  emaci- 
ated'; on  rising  in  bed  complained  of  entire  deafness  ; great 
alteration  of  voice.  An  emetic  of  tart.  ant.  and  ipecac,  fol- 
lowed by  strong  eupatorium  tea,  till  he  vomited  and  sweated 
profusely.  Hot  water  and  camphorated  spirits  frequently  re- 
peated for  3 hours,  and  then  to  be  wiped  dry.  The  intes- 
tinal discharges  were  promptly  arrested.  After  3 hours, 
gave  small  doses  of  Dover’s  powder  and  camphor,  mucil- 
ages and  spirits  of  mtre  as  a drink. 

August  30.  Bilious  stools.  Recovered  from  this  time. 

Case  6. — Mrs.  H.  iEt.  42.  September  10,  A.  M.  Has 
had  diarrhoea  3 or  4 days,  at  first  milky,  afterwards  almost 
colourless.  Has  greatly  increased  for  several  hours,  and  she 
has  vomited  several  times.  Dejectious  very  clear,  and  of  a 

* This,  Case  14,  and  (he  preceding  case,  were  obligingly  furnished  by  a profes- 
sional friend,  Dr.  Stillman  Spooner,  of  Wampsville. 


122 


Spencer  on  Asiatic  Cholera. 


urinous  smell.  Although  the  evacuations  have  been  pro- 
fuse, there  is  scarce  a pain  in  any  organ.  Pulse  feeble,  sur  - 
face moist  and  cold,  countenance  emaciated,  hands  slight- 
ly corrugated  ; voice  plaintive.  Gave  full  emetic  of  em, 
tart,  and  ipecac,  followed  by  large  draughts  of  eupatorium 
tea.  Vomiting  and  sweating  free ; diarrhoea  at  once  sus- 
pended. Gave  a wine  glass  of  hot  water,  with  a few  drops 
of  camphorated  spirits,  every  half  hour  for  3 hours,  then 
wiped  with  hot  chalk  and  flannel.  Then  to  give  a powder 
of  camph.  3 grs.,  crem.  tart.  gr.  8,  ipecac,  gr.  4,  a tea 
spoonful  of  spts.  nitre,  and  the  camphor  and  hot  urater  each 
every  three  hours.  Elm  and  gum  arabic  teas  for  drink. 

7,  p.  M.  Pulse  more  full  and  soft,  skin  moist,  no  di- 
arrhoea or  vomiting.  Return  of  urinary  secretion,  which 
had  been  suspended  24  hours.  Had  2 or  3 bilious  stools 
during  the  night. 

September  11.  Took  some  breakfast,  and  with  it  a small 
piece  of  cheese.  Serous  discharges  from  the  bowels  soon 
followed  by  vomiting.  Being  very  feeble  at  10,  a.  m.,  a 
professional  neighbor  ordered  an  enema  of  laud.  60  drops 
and  a spoonful  of  saturated  solution  acetate  of  lead. 
This  stayed  the  disease  for  an  hour  or  two,  when  vomiting 
became  a troublesome  symptom,  every  thing  taken  suddenly 
being  rejected.  Large  epispastic  to  epigastrium.  Powder  of 
camph.  gr.  2,  cal.  | gr.  every  two  hours,  in  a small  pow- 
der of  loaf  sugar.  Gum  arabic  water,  a tea  spoonful  every 
half  hour.  Every  thing  else  forbidden. 

7,  P.  M.  Vomiting  had  ceased  after  the  above  prescrip- 
tion. A little  crem.  tart,  and  ipecac,  added  to  the  pow- 
ders, and  these  continued  every  two  hours,  alternated  with 
20  drops  spts.  nitre  ; mucilages. 

September  12.  9,  A.  M.  Has  had  no  stools.  Ordered  24 

grs.  rhei.  and  10  grs.  carb.  magnesia,  combined  with  ginger, 
half  to  be  given  at  intervals  of  3 hours.  Operated  5 times, 
dark  bilious  stools.  Calomel  left  out  of  powders.  These, 
and  spirits  of  nitre,  continued  every  four  hours  each  after 


Spencer  on  Asiatic  Cholera. 


123 


the  cathartic.  Columbo  tea  every  6 hours,  with  a moder- 
ate allowance  of  wine.  Cured. 

Case  7. — G.  _ZEt.  1|  year.  September  8.  1,  p.  M. 

Had  previously  labored  under  diarrhoea  for  several  weeks, 
which  had  been  several  times  checked  ; but  the  treatment 
was  unknown.  Has  had  profuse  rice-coloured  serous  dis- 
charges from  the  bowels  for  8 or  10  hours,  vomiting  for  2 
or  3.  Pulse  feeble  ; countenance  exceedingly  emaciated, 
and  eyes  sunk  deep  in  the  sockets,  cold  extremities.  Emet- 
ic of  sulph.  zinc,  grs.  3,  ipecac,  grs.  5 ; to  be  divided  in- 
to 4 doses,  and  given  every  5 minutes.  The  vomiting  and 
purging  ceased  immediately.  Nearly  a half  ounce  of  ipe- 
cac was  given  in  divided  doses,  ether  and  carb.  ammonia 
were  severally  combined  with  these,  but  vomiting  could  not 
be  induced  under  half  an  hour.  Strong  eupatorium  tea 
was  then  given  till  full  vomiting  and  sweating  were  induced. 
The  advanced  stage  of  the  disease  rendered  it  necessary  to 
cautiously  avoid  the  too  long  continuance  of  the  free  per- 
spiration, but  the  skin  remained  moist  for  24  hours.  A 
moderate  allowance  of  wine  whey,  mucilages  and  spirits  of 
nitre  for  drinks. 

September  9.  8.  A.  M.  No  return  of  diarrhoea.  A 

powder  of  calomel,  gr.  |,  camph.  and  crem.  tart,  a a gr.  1, 
ipecac  \ ; give  every  6 hours  for  48  hours,  and  continue 
spirits  of  nitre  and  gum  arabic. 

September  11.  Tea  of  aromatic  powder.  No  return  of 
diarrhoea. 

Case  8. — Mrs.  B.  Alt.  34.  Of  feeble  nervous  consti- 
tution, habituated  to  the  use  of  opium. 

September  10.  12,  A.  M.  Has  had  diarrhoea  2 or  3 

days  ; at  first  bilious,  then  serous,  and  very  profuse  for  some 
time,  and  has  vomited  several  times  a rice-coloured  fluid, 
pulse  feeble,  faintness  in  erect  posture,  cramps  of  abdom- 
inal muscles,  skin  dry.  Medical  attendant  gave  emet. 
tartar  grs.  3,  ipecac,  grs.  30  ; one  third  every  15  minutes, 
to  be  followed  by  eupatorium  tea.  Vomited  6 or  8 times, 


124 


Spencer  on  Asiatic  Cholera. 


but  did  not  sweat  freely.  Spirits  of  nitre,  hot  water  and 
camph.  frequently  given. 

9,  A.  M.  First  saw  her.  Symptoms  better,  but  moderate 
diarrhoea  continues.  Enema  of  sacchar  satur.  grs.  20,  laud. 
60  drops ; pills  of  sac.  sat.  grs.  2,  opium  gr.  to  be  re- 
peated in  an  hour,  unless  diarrhoea  ceases.  Promptly  check- 
ed. Powders  of  camph.  and  crem.  tart,  a a grs.  3,  cal. 
and  ipecac  a a J gr.,  half  tea  spoonful  spts.  nitre  and  cam- 
phor julep,  each  once  in  eight  hours.  Mucilages. 

September  11.  9,  a.  M.  Stomach  and  bowels  quiet. 

Rhei,  grs.  24,  mag.  calc.,  grs.  6,  one  half  at  intervals  of 
3 hours.  Operated  favorably.  Columbo  tea  and  mu- 
cilages. 

Case  9. — T.  M.  iEt.  43.  Of  intemperate  habits,  and 
broken  down  constitution. 

September  12.  Taken,  with  common  cholera  morbus, 
which  readily  yielded  to  ordinary  treatment. 

September  14.  Ate  a meal  of  mutton,  and  exposed  him- 
self to  cold  air.  Taken  in  the  night  with  diarrhoea,  at  first 
tinged  with  bile,  but  soon  becoming  serous  and  profuse. 

September  15.  12,  M.  Has  been  vomiting  near  3 hours, 

profuse  discharges  of  serous  fluids  from  stomach  and  bow- 
els, pulse  very  feeble,  intense  thirst,  moist  slimy  tongue, 
some  gripings,  cold  clammy  sweat,  cold  extremities,  severe 
spasms  of  the  extremities,  emaciated  countenance,  voice 
plaintive.  Sulph.  zinc,  grs.  6,  ipecac,  grs,  35,  in  warm 
water,  one  third  every  ten  minutes,  to  be  followed  by  warm 
eupatorium  tea.  Vomited  promptly,  free  warm  perspiration 
ensued,  and  diarrhoea  at  once  ceased.  Glass  of  hot  sweet- 
ened water  and  camphorated  spirits  every  20  or  30  minutes, 
for  2 hours,  then  to  be  wiped  with  hot  chalk  and  flannel 
under  the  bed  clothes,  and  these  lightened. 

3,  P.  M.  All  the  symptoms  favorable.  Pow.  camph.  grs. 
3,  crem.  tart.  grs.  8,  ipecac,  gr.  i,  30  drops  spirits  nitre 
dul.  and  the  hot  water  and  camph.  to  be  given  at  the  follow- 
ing hours : 


Spencer  on  Asiatic  Cholera . 


125 


Powder,  at  12,  3,  6,  9,  o’clock. 

Spirits  nitre,  at  1,  4,  7,  10,  do. 

Camph.  and  water,  at  2,  5,  8,  11,.  do. 

September  16.  9,  A.  M.  Urine  had  been  voided.  Mo- 

derate return  of  diarrhoea.  Sac.  sat.  grs.  20;  laud,  guttse, 
20,  in  thin  starch,  which  promptly  checked  the  diarrhoea.  Cal. 
and  ipecac,  a a gr.  camph.  and  crem.  tart,  each  grs.  3, 
and  spirits  nit.  kc.  as  yesterday.  Gum  arabic  as  drink. 

September  17.  Bilious  stools.  Continue  spts.  nit.  and 
gum  arabic  ; omit  powders.  Columbo  tea  and  port  wine. 

Case  10. — September  15.  R.  F.  iEt.  70.  A farmer. 
Taken  with  milky  diarrhoea,  which  soon  became  serous,  at- 
tended with  some  griping  pains  in  the  afternoon. 

September  16.  1,  A.  M.  Taken  with  vomiting. 

3,  p.  M.  Medical  attendant  found  him  with  the  following 
symptoms : Profuse  watery  discharges  from  bowels,  vom- 
iting had  ceased,  voice  a whisper,  pulse  almost  imperceptible, 
extremities  cold,  skin  of  hands  corrugated,  cold  tongue, 
breath  giving  a cold  sensation  to  the  hand,  countenance 
emaciated,  no  urine  had  been  voided  for  24  hours,  scarcely 
any  pain.  An  emetic  of  tart,  antimony,  grs.  6,  ipecac- 20 
grs.,  followed  by  strong  eupatorium  tea,  and  hot  camphor 
julep,  but  these  did  not  produce  free  perspiration. 

10,  A.  M.  I first  saw  him.  Diarrhoea  continues  moder- 
ately. Dusky  brown  appearance  of  skin,  low  wail  of  voice, 
cold  extremities,  pulse  feeble,  about  90  in  a minute,  but 
variable,  respiration  slow,  has  voided  no  urine.  Enema 
of  sac.  sat.  grs.  20,  laud,  guttm  60,  in  thin  starch  ; hot 
frictions.  Powders  of  camphor,  5 grs.,  crem.  tart.  grs. 
8,  ipecac,  gr.  spirits  of  nitre,  dulc.  1 tea  spoonful,  and  a 
wine  glass  of  hot  sweetened  water,  with  spts.  camph.,  each 
every  3 hours,  alternately  ; mucilages.  Port  wine,  if  pa- 
tient sinks  too  low,  but  little  taken  ; hot  frictions. 

8,  p.  M.  Intestinal  evacuations  ceased,  moderate  perspi- 
ration, pulse  more  full  and  soft ; continue  same  prescrip- 
tion. 


17 


126 


Spencer  on  Asiatic  Cholera. 


September  17.  9,  a.  m.  Has  had  several  bilious  -stools, 

and  a return  of  urinary  discharge.  Continue  spirits  nitre, 
and  mucilages  as  drinks ; chicken  tea  and  rice  as  food. 
Golumbo  tea  and  port  wine.  Slowly  recovered. 

CASE  11. — H.  L.  iEt.  65.  Very  intemperate  habits. 

August  15.  11,  A.  M.  Taken  with  profuse  diarrhoea, 

while  laboring  in  the  field. 

4,  P.  M.  Severe  vomiting  and  purging  of  rice-coloured 
fluids,  with  flocculse,  pulse  feeble,  and  120  in  a minute  ; se- 
vere spasms  of  the  abdominal  muscles  and  extremities  ; in- 
tense thirst ; burning  sensation  in  the  epigastrium.  Laud- 
anum and  ether  repeatedly  given  ; hot  bottles,  frictions,  cal- 
omel and  opium,  enemas  of  starch,  and  laud,  frequently  re- 
peated. 

6,  p.  M.  Vomiting  and  purging  continue  ; cold  perspi- 
ration, corrugated  hands,  pulseless  wrist.  On  getting  up, 
swooning,  followed  by  convulsions,  which  soon  subsided. 
Cold  affusion,  stimulants,  opiates,  &c. 

8,  p.  M.  Complete  collapse,  voice  a whisper,  marble  cold- 
ness, pulseless,  slow  breathing,  and  every  appearance  of  im- 
mediate dissolution.  Venous  injections.  Carb.  soda,  s.  4, 
muriate  of  soda,  oz.  1|,  and  the  white  of  6 eggs  diffused  in  10 
lbs.  warm  water,  strained.  8 lbs.  were  injected  into  the  bas- 
ilic vein,  pulse  became  perceptible,  spoke  distinctly,  able  to 
rise  in  bed,  warmth  returned.  Continued  better,  except  occa- 
sional vomiting  and  purging,  until 

9g,  p.  M.  Began  rapidly  to  sink,  and  soon  pulseless.  Re- 
maining 2 lbs.  saline  fluids  injected  with  no  less  apparent  ben- 
efit, but  of  shorter  duration.  Return  of  vomiting  and  purg- 
ing. Laud,  ether,  stimulants,  frictions,  <fcc.  of  no  avail. 

12  o’clock.  Died  soon  after  this  hour. 

Case  11. — H.  W.  iEt.  about  38.  Of  very  intemperate 
habits. 

August  1 S.  Had  labored  under  diarrhoea  for  2 or  3 days. 
The  above  case  (11 ) having  terminated  fatally  in  his  house, 
a justice  of  the  peace,  with  the  best  intentions,  recommended 
bilious  pills  as  a preventive,  and  the  whole  family  about  1 0 in 


Spencer  on  Asiatic  Cholera. 


127 


number,  were  most  of  them  dosed  with  them.  [Three  of  his 
children  had  suddenly  died  with  the  severe  vomiting  and  purg- 
ing of  serous  fluids,  notwithstanding  the  most  persevering  use 
of  calomel  and  opium  pills,  laudanum,  injections,  stimulants, 
hot  bottles,  frictions,  &c.]  Vomiting  and  profuse  serous  dis- 
charges from  the  bowels,  spasms,  in  which  the  muscles  rose 
into  hard  balls,  profuse  cold  sweat,  cold  extremities,  emaciated 
countenance,  low  wail  of  voice  progressively  came  on,  the 
pulse  rapidly  sinking.  During  this  time  he  took  calomel  and 
opium,  starch  and  laud. ; enemas,  ether,  and  other  stimulants 
were  employed  as  collapse  threatened,  and  doses  of  piperine, 
5 gi'o,  and  quin.  2 grs.,  every  half  hour,  and  evacuations  be- 
came less  frequent ; dry  heat  and  frictions,  &c. 

Towards  evening  a preacher,  who  has  great  faith  in  what 
are  called  steam  doctors,  and  hot  drops,  returning  from  a neigh- 
boring city  with  a certain  cure  for  cholera,  sent  in,  as  he  wa3 
passing,  some  of  his  medicines,  which  the  patient  was  willing  to 
take,  having  witnessed  the  fatality  of  the  other  cases.  He 
took  one  dose  of  hot  medicines,  which  were  soon  vomited,  but 
not  liking  the  taste  resolved  to  take  no  more  medicines  of  any 
description  ; stripped  off  the  heavy  covering  of  bed  clothes, 
and  hot  bottles  removed. 

8,  P.  M.  Several  medical  gentlemen  called  to  see  the  pro- 
gress. Patient  cold  over  the  whole  surface,  clammy  sweat, 
corrugated  hands,  great  emaciation  of  countenance,  and  a 
dusky  brown  appearance,  low  wail  of  voice,  pulse  scarcely 
perceptible,  and  at  times  entirely  receding,  occasional  spasms, 
discharges  from  the  bowels  almost  suspended.  Bad  prognosis, 
unanimously.  The  patient  during  the  night  took  moderate 
draughts  of  cold  water,  and  occasionally  a little  brandy,  lay 
nearly  naked,  and  did  as  he  pleased. 

August  19.  Convalescing,  in  spite  of  the  prescriptions  of 
justice,  regular  physicians,  or  preacher. 

Case  13. — M.  J.  JEt.  17.  Has  had  repeated  attacks 
of  serous  diarrhoea,  which  had  been  checked  with  camphor 
and  opium  pills,  laudanum,  &c.  followed  by  warm  drinks,  laxa- 
tives, &c. 


128 


Spencer  on  Asiatic  Cholera. 


August  29.  Found  his  skin  hot  and  dry,  pain  in  his 
head,  redness  of  eyes,  pulse  1 20,  and  sharp,  restlessness,  thirst, 
white  tongue,  red  at  the  edges.  The  febrile  symptoms  had 
continued  several  hours.  Cold  affusion,  followed  by  an  emetic 
and  warm  drinks,  which  vomited  and  sweat  him  freely.  Usual 
febrifuge  medicines. 

August  30.  All  the  febrile  symptoms  subsided,  pulse  about 
70,  soft.  All  the  secretions  and  excretions  returned.  Had  no 
return  of  intestinal  or  febrile  disease. 

Case  14. — Mrs.  B.  iEt.  70.  Had  suffered  two  or  three 
attacks  of  severe  serous  diarrhoea  which  had  been  checked  by 
opiates,  followed  by  calomel,  rhei,  &c.  under  the  prescription 
of  a neighboring  physician. 

September  19.  12,  M.  Having  suffered  from  severe  dis- 

charges from  the  bowels,  and  becoming  alarmed,  she  took  as 
a domestic  prescription,  laudanum,  which  immediately  checked 
the  complaint. 

10,  p.  m.  Found  her  with  slight  perspiration,  pulse  strong, 
bounding  and  full,  was  very  stupid,  slight  delirium.  The  skin 
soon  became  hot  and  dry. 

September  20.  12  a.  m.  Cold  affusion,  followed  by  an 

emetic  of  ipecac,  and  warm  drinks,  to  be  covered  warm  in  bed, 
to  be  followed  by  hot  camphor  julep  every  half  hour  for  three 
hours.  Vomited  and  sweat  freely.  Laxative  of  cal.  and 
rhei. 

12  m.  Fever  subsided.  Laxative  had  produced  bilious 
stools.  Drinks  of  gum  arabic,  soda  and  spirits  of  nitre.  Bitter 
tea. 

Case  15. — N.  F.  JEt.  4.  For  a week  he  had  repeated 
attacks  of  serous  diarrhoea,  alternating  with  costiveness. 

September  5.  Taken  with  profuse  serous  diarrhoea  for 
which  the  family  gave  him  25  drops  of  laudanum,  and  this  not 
checking  the  disease,  it  was  soon  repeated.  The  diarrhoea  was 
suddenly  checked,  and  the  urinary  secretion  almost  suspended. 
Patient  lay  in  a torpid  state  without  medical  aid,  till 

September  7.  S,  A.  m.  Had  vomited  several  times  during 
the  day,  and  had  several  watery  discharges  from  the  bowels 


Spencer  on  Asiatic  Cholera. 


129 


the  night  before,  more  since,  pulse  full  and  quick,  skin  cover- 
ed with  clammy  sweat,  thirst  urgent,  white  fur  of  tongue. 
Tepid  affusion,  followed  by  an  emetic  of  ipecac,  and  warm 
drinks,  which  produced  free  perspiration.  Followed  with 
laxative  of  rhei  and  crem.  tartar.  A solution  of  emetic  tar- 
tar once  in  2 hours. 

September  8.  8,  a.  m.  Has  been  restless,  pain  in  the  head, 
eyes  suffused,  pulse  quick  and  hard,  skin  hot  and  dry,  respira- 
tion quick,  bowels  loose.  Bled  8 or  10  oz.  nearly  to  fainting. 
Powds.  cal.  gr.  crem.  tart.  gr.  4,  em.  tart.  gr.  4,  spirits  of 
nitre  25  drops,  and  the  solution  of  emetic  tart,  to  be  each 
given  every  3 hours  alternately.  Epispas.  to  back  of  neck, 
and  cold  to  the  head,  and  to  be  elevated. 

September  9.  9,  a.  m.  Pain  in  the  head  severe,  great  in- 

tolerance of  light,  knitting  of  eye  brows,  mind  irritable  and 
wandering,  complains  of  great  increase  of  pain  on  shaking  the 
head,  universal  soreness  of  the  body,  pulse  quick,  sharp  and 
hard,  skin  hot  and  dry.  Cold  affusion.  As  soon  as  reaction 
was  fully  established,  bled  8 oz.  Ipecac,  grs.  15,  was  given 
in  divided  doses,  followed  by  warm  drinks  ; moderate  em- 
esis, and  free  perspiration  followed.  Same  prescription  as 
yesterday.  Much  relieved  for  some  hours,  but  at  6,  evening, 
pulse  still  quick,  and  somewhat  variable,  pain  in  head  continues, 
sensibility  to  light,  rather  comatose,  and  exceedingly  cautious 
about  moving.  Bled  6 oz.  Epispastic  nearly  whole  length 
of  spine. 

September  10.  9,  a.  m.  No  motion  of  bowels  for  12 

hours,  symptoms  a little  relieved.  Cal.  5 grs.  were  added  to 
each  powder,  till  3 were  given,  followed  by  castor  oil.  Emetic 
tartar  solution  to  be  omitted. 

7,  evening.  Symptoms  better.  Cathartic  had  operated 
favorably.  Powders  once  in  3 hours,  alternated  with  spirits 
of  nitre  and  acetate  of  soda  as  drinks. 

September  11.  Much  better,  left  the  calomel,  the  powders 
at  longer  intervals. 

12  and  13.  Convalescing.  Light  diet  and  mild  drinks. 

Case  16.  C.  L.  Mi.  6 years.  September  29.  Ta- 
ken with  severe  diarrhoea  of  milk  and  water  colour. 


130 


Spencer  on  Asiatic  Cholera. 


11,  evening.  Nausea,  some  vomiting,  profuse  discharges 
from  the  bowels,  strength  rapidly  failing,  pulse  quick  and 
sharp,  respiration  hurried,  whitish  fur  of  tongue,  skin  dry. 
The  medical  attendant  directed  tart.  ant.  grs.  2,  ipecac,  grs. 
25,  to  be  given  in  3 doses  at  intervals,  to  be  put  in  warm  bed, 
and  to  drink  freely  of  warm  drinksj  and  afterwards  camphorat- 
ed spirits,  and  hot  water,  every  15  minutes.  Vomited  several 
times,  but  no  perspiration.  The  diarrhoea  continued  profuse, 
became  alarming,  and  the  mother  gave  her  a few  drops  of 
laudanum. 

September  30.  3,  a.  m.  Some  vomiting,  profuse  serous 

discharges  from  the  bowels,  pulse  quick,  and  somewhat  sharp, 
skin  dry,  strength  rapidly  failing.  Enema  of  a few  drops  of 
laud.,  and  solution  of  sac.  sat.  This  not  checking  the  discharg- 
es, was  soon  repeated.  This  checked  the  discharges.  Mu- 
cilages and  spts.  nitre  as  drinks. 

10,  a.  m.  No  motion  of  bowels,  or  discharge  of  urine , 
pulse  rather  quick,  skin  dry,  slight  determination  to  the  head. 
Powders  of  cream  tartar  3 grs.,  ipecac  gr.  £,  every  two  hours, 
with  15  drops  spts.  nit.  in  the  intervals.  Gum  water  as  com- 
mon drink. 

9,  p.  m.  Pulse  full,  quick  and  strong,  comatose,  roused 
with  difficulty,  respiration  laborious,  no  intestinal  or  urinary 
discharges,  skin  dry  and  hot.  Bled  10  oz.  Put  in  warm 
bath  15  minutes.  Roused  up,  became  more  sensible,  com- 
plained much  of  the  light,  h oz.  ol.  ricini,  to  be  repeated  in 
half  an  hour ; large  epispastic  to  nape  of  neck.  Powders  crem. 
tart.  4 grs.,  ipecac,  gr.  every  two  hours,  alternately  with 
spirits  of  nitre. 

October  1.  8,  a.  m.  Bowels  moved  but  once,  pulse  quick, 

less  comatose,  no  discharge  of  urine,  headache  severe,  intoler- 
ance of  light,  conjunctiva  red.  Discharge  from  nose,  skin  dry, 
not  softened  by  warm  bath.  Bled  10  oz.  and  scarified  and 
cupped  the  temple,  with  immediate  relief  to  head.  Cal.  grs. 
15,  rhei  10  grs.,  one  half  at  interval  of  1 hour  as  cath.  Epis- 
pastic behind  each  ear.  After  cathartic,  6 grs.  cal.  were  added 


Spencer  on  Asiatic  Cholera- 


131 


to  each  powder,  and  repeated  every  2 hours,  to  be  suspended 
if  they  operated  too  much.  Crcm.  tart,  as  drink. 

October  2.  8,  a.  m.  Pulse  variable,  from  114  to  120, 

soft  and  full,  eyes  sensible  to  light,  head  ache,  3 evacuations 
from  bowels,  of  green  bilious  appearance.  Cal.  grs.  5,  crcm. 
tart.  grs.  6,  cm.  tart.  gr.  J,  every  3 hours,  and  30  drops  spts. 
nit.  in  intervals.  Scarified  and  cupped  temple,  with  great 
relief  to  the  head. 

8,  p.  m.  Pulse  quick  and  hard,  120,  skin  rather  cool,  but 
dry ; eyes  very  sensible  to  light,  comatose.  Cold  affusion, 
followed  by  15  grs.  ipecac,  which  produced  vomiting,  and 
some  perspiration  for  the  first  time. 

10,  p.  m.  Pulse  from  110  to  115,  soft,  very  little  pain  in 
the  head,  skin  softer  and  moist.  Continued  the  powders,  #c. 
in  less  doses,  same  intervals. 

October  3.  Head  much  relieved,  lively  expression  of  coun- 
tenance, eyes  less  sensible  to  light,  copious  discharge  of  urine 
in  the  night,  and  discharge  from  bowels  like  coffee  grounds, 
skin  soft  and  moist.  Recovered  slowly  from  this  time. 


ERRATA. 

Pago  10,  line  4 from  bottom,  for  “ all  of,”  road  of  all. 

13,  line  4 from  bottom,  strikeout  (;)  after  “ hot,”  and  insert  a comma 

after  cold. 

14,  line  13,  for  “ sometimes,”  read  sometime. 

20,  Note,  for  Prof.  Thomson  of  “ Edinburgh,”  read  Glasgow. 

23,  line  5 from  bottom,  for  “influenza,”  read  influence. 

31,  line  4,  for  “ last  be,”  read  best  be. 

32,  line  17,  for  “ spasms,”  read  pains  in  the  hepatic  region. 

37,  line  4 from  the  bottom,  for  “ is  it,”  read  it  is. 

51,  line  5,  for  “ venal,”  read  renal. 

65,  line  13,'  for  “ mucous  ingesta,”  read  mucus,  ingesta. 

67,  line  12,  for  “ quantities,”  read  qualities. 

84,  line  19,  for  “ supposed,”  read  suffered. 

100,  line  5 from  bottom,  for  “aid,”  read  ,add. 

104,  Note,  for  “ Revene,”  read  Revere. 

104,  line  16,  for  “ sup.  carb.  sod.  scrup,  1,”  read  dr.  1 ; and  for  " mu- 
riat.  sod,  dr,  1,”  read  scrup.  1, 


I 

Spencer 


